Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to episodes of severe hypoglycemia. This condition is often considered first due to its direct link with insulin overproduction and the resulting hypoglycemic episodes.

Type 1 Diabetes with Over-Insulinization: Patients with type 1 diabetes who take too much insulin can experience recurrent severe hypoglycemia. This is a common issue due to the fine balance required in insulin dosing.
Type 2 Diabetes with Insulin or Sulfonylurea Therapy: Similar to type 1 diabetes, patients with type 2 diabetes on insulin or sulfonylureas can experience hypoglycemia if their medication doses are not appropriately matched to their dietary intake and physical activity.
Alcohol-Induced Hypoglycemia: Alcohol can cause hypoglycemia, especially in individuals who drink heavily without eating. This is due to alcohol's inhibitory effect on gluconeogenesis.
Hypopituitarism: A condition where the pituitary gland does not produce one or more of its hormones, or not enough of them. This can lead to deficiencies in hormones like growth hormone and cortisol, which play roles in glucose metabolism and can cause hypoglycemia.

Adrenal Insufficiency: A condition where the adrenal glands do not produce adequate amounts of hormones, including cortisol and aldosterone. Cortisol plays a crucial role in glucose metabolism, and its deficiency can lead to hypoglycemia. Missing this diagnosis can be fatal.
Hypothyroidism: Although less directly linked to hypoglycemia, severe hypothyroidism can contribute to decreased glucose production and increased sensitivity to insulin, potentially leading to hypoglycemia.
Celiac Disease: An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. It can cause malabsorption of nutrients, including those necessary for glucose production, potentially leading to hypoglycemia.

Glycogen Storage Diseases: A group of inherited disorders characterized by the inability to break down glycogen to glucose, leading to hypoglycemia.
Glucagon Deficiency: A rare condition where the pancreas does not produce enough glucagon, a hormone that raises blood glucose levels.
Fatty Acid Oxidation Disorders: Genetic disorders that affect the body's ability to break down fatty acids for energy, leading to hypoglycemia during fasting periods.
Ketotic Hypoglycemia of Childhood: A condition seen in children, characterized by hypoglycemia accompanied by ketosis, often triggered by fasting or inadequate food intake.