Differential Diagnosis for Hypoglycemia in Ms. Lachone Johnson
Single Most Likely Diagnosis
- Adrenal Insufficiency: Despite the normal cortisol and ACTH levels, and a negative repeat ACTH stimulation test, the patient's history of possible adrenal insufficiency, previous inadequate response to cosyntropin stimulation test, and the clinical presentation of hypoglycemia and hypothermia suggest that adrenal insufficiency could still be a contributing factor, especially considering the patient was on hydrocortisone which was discontinued.
Other Likely Diagnoses
- Sepsis-related Hypoglycemia: The patient was admitted with sepsis, which can cause hypoglycemia due to increased glucose consumption by the body and impaired glucose production.
- Medication-induced Hypoglycemia: Although not explicitly mentioned, certain medications can cause hypoglycemia, and given the patient's complex medical history, it's possible that a medication could be contributing to the hypoglycemia.
- Malnutrition or Starvation: As a nonverbal, wheelchair-bound patient with a history of multiple hospitalizations for pneumonia, malnutrition or starvation could be a factor, especially if the patient has not been receiving adequate nutrition.
Do Not Miss Diagnoses
- Hypopituitarism: This condition, which involves the underproduction of one or more pituitary hormones, could lead to adrenal insufficiency and hypoglycemia. Given the patient's complex presentation, it's crucial not to miss this diagnosis.
- Insulinoma or Other Insulin-related Tumors: Although rare, these conditions can cause hypoglycemia and would be critical to diagnose due to their potential for malignancy and the need for specific treatment.
- Factitious Hypoglycemia: Given the patient's dependence on caregivers, the possibility of factitious hypoglycemia (induced by administration of insulin or other hypoglycemic agents) should be considered, especially if there are inconsistencies in the patient's care or suspicious behaviors by caregivers.
Rare Diagnoses
- Glucose-6-Phosphatase Deficiency (Von Gierke's Disease): A rare genetic disorder that affects glucose metabolism and can cause hypoglycemia, although it typically presents in childhood.
- Glycogen Storage Diseases: Other rare genetic disorders that affect glycogen synthesis or breakdown, potentially leading to hypoglycemia.
- Ketotic Hypoglycemia: A condition more common in children but can occur in adults, characterized by hypoglycemia with ketosis, often related to fasting or starvation states.