Hypoglycemia
Fasting Hypoglycemia
Overutilization of glucose
Autoimmune
Antiidiotypic antibodies to antiinsulin antibodies
Antiinsulin antibodies
Antiinsulin receptor antibodies (stimulating) (including type B extreme insulin resistance)
Deficiency of enzymes of fat oxidation and ketogenesis
Carnitine palmitoyltransferase deficiency (less common)
Electron transport flavoprotein deficiency
Electron transport flavoprotein dehydrogenase
deficiency
Hepatic hydroxymethyl glutaryl coenzyme A (HMG CoA) lyase deficiency
Medium and long chain acyl-CoA dehydrogenase
deficiency
Short and long chain 3-OH acyl-CoA dehydrogenase deficiency
Systemic carnitine deficiency
Drug-induced overutilization (factitious or iatrogenic)
Insulin
Metformin accompanied by
Deficient caloric intake
Ethanol
Strenuous exercise
Other glucose-lowering agents (insulin, sulfonylureas, probably repaglinide)
Repaglinide
Sulfonylureas
Vacor (acutely)
Extrapancreatic tumors
Adrenocortical carcinomas
Bulky mesenchymal tumors
Fibrosarcomas
Hemangiopericytomas
Leiomyosarcomas
Liposarcomas
Lymphosarcomas
Mesotheliomas
Rhabdomyosarcomas
Carcinoidlike tumors
Gastrointestinal carcinomas
Hepatomas
Lymphomas/leukemias
Other (teratoma, kidney, ovary)
Insulin excess
Discontinuation of total parenteral nutrition
(transient)
Erythroblastosis fetalis (transient)
Infants of diabetic mothers (transient)
Pancreatic beta cell disorders
Adenomatosis
Beckwith-Wiedemann syndrome
Insulinoma
Islet cell hyperplasia
Leprechaunism
Nesidioblastosis
Prolonged exercise (less likely in trained athletes)
Underproduction of glucose
Congestive heart failure
Deficiencies of insulin counter-regulatory hormones
Adrenal hyporesponsiveness of small for gestational age (SGA) babies
Adrenal insufficiency
Epinephrine deficiency (infants)
Glucagon deficiency
Growth hormone deficiency (children; adults after prolonged fasting)
Hypopituitarism (less common older than age 6 years)
Hypothyroidism
Uremia
Drug- or toxin-induced hypoglycemia
Angiotensin-converting enzyme inhibitors
Acetaminophen
Acetazolamide
Aluminum hydroxide
Anabolic steroids
Azapropazone
Beta blockers
Buformin
Carbutamide
Chloramphenicol
Chloroquine
Chlorpromazine
Cibenzoline
Cimetidine
Clofibrate (potentiates sulfonylureas)
Coumarin derivatives
Cycloheptolamide
Diphenhydramine
Disopyramide
Doxepin
Ethylenediaminetetraacetic acid
Encainide
Ethanol (blood alcohol levels may not be elevated when patient is hypoglycemic)
Fenoterol
Guanethidine
Haloperidol
Hypoglycin (unripe ackee fruit ingestion, “Jamaican vomiting illness”)
Imipramine
Indomethacin
Isoproterenol
Isoxsuprine
Lidocaine
Lithium
Mebanazine
Mebendazole
Mesoxylate
Methimazole (autoimmune insulin syndrome)
Monoamineoxidase inhibitors
Orphenadrine
Ouabain
Oxytetracycline
Paraaminobenzoic acid
Paraaminosalicylic acid
Penicillamine (autoimmune insulin syndrome)
Pentamidine
Perhexiline
Phenindione
Phenylbutazone
Potassium paraaminobenzoate
Probenecid
Propoxyphene (in chronic renal failure)
Pyritinol (autoimmune insulin syndrome)
Quinidine (in treatment of cerebral malaria)
Quinine (i.v., in treatment of cerebral malaria)
Ranitidine
Ritodrine
Salicylates (children, and topical application for psoriasis in chronic renal failure patients)
Sulfadiazine
Sulfonamides
Terbutaline
Tris(hydroxymethyl)-aminomethane
Falciparum malaria (children)
Disorders of gluconeogenesis
Genetic disorders of amino acid metabolism
Disorders of branched-chain amino acid metabolism
Glutaric aciduria (type II)
Maple syrup urine disease
Organic acidemias
Methylmalonic acidemias
Propionic acidemia
Fructose-1,6-bisphosphatase deficiency
Phosphoenolpyruvate carboxykinase deficiency
Pyruvate carboxykinase deficiency
Glycogen synthesis and breakdown, disorders of
Glycogen storage diseases
Type I
Glucose-6-phosphatase deficiency
Glucose-6-phosphate translocase deficiency
Type III (debranching enzyme deficiency)
Type VI
Hepatic glycogen phosphorylase deficiency
Hepatic glycogen phosphorylase kinase deficiency
Glycogen synthase deficiency
Hepatic dysfunction (severe)
Hypothermia
Idiopathic hypoglycemia of infancy and childhood
Kidney transplantation, in children
Lactic acidosis
Removal of pheochromocytoma
Reye's syndrome
Sepsis
Substrate deficiency
Ackee fruit ingestion
Fasting hypoglycemia of pregnancy (late)
Ketotic hypoglycemia of infancy
Severe malnutrition (including anorexia nervosa and extreme food faddism)
Transient neonatal hypoglycemia (felt secondary to inadequate substrate or enzyme function), especially
Maternal toxemia
Prematurity
Respiratory distress
Small for gestational age
Smaller of twins
Type I glucose transporter defect, inherited (in children—normal plasma glucose but low cerebrospinal fluid glucose)
Uremia
Reactive Hypoglycemia*
Induced by glucose
Alimentary
Gastrojejunostomy
Partial or total gastrectomy
Peptic ulcer disease
Pyloroplasty
Rapid gastric emptying
Thyrotoxicosis
Vagotomy
Early type 2 diabetes mellitus (uncommon)
Endocrine deficiencies
Adrenal insufficiency
Hypothyroidism
Functional/idiopathic/spontaneous reactive hypoglycemia
Insulinoma (occasionally)
Induced by other substrates
Fructose intolerance, hereditary
Galactosemia
Leucine-induced hypoglycemia
Factors Causing Increased Frequency of Hypoglycemia in Previously Compensated Diabetic Patients
Adrenal insufficiency
Antiinsulin antibodies (as a result of exposure to exogenous insulin)
Autoimmune
Decreased caloric intake
Development of hypoglycemic unawareness
Drugs and toxins
Ethanol
Hypopituitarism
Hypothyroidism
Increased exercise
Renal failure
Weight loss
References
1. Service FJ: Hypoglycemic Disorders.
N Engl J Med 332:1144–1152, 1995.
2. Foster DW, Rubenstein AH: Hypoglycemia, pp. 2082–2084. See Bibliography, 1.
*Twenty-five percent of asymptomatic controls have been reported to have symptomatic hypoglycemia during 5-hour oral glucose tolerance tests.
Consider a diagnosis of “pseudohypoglycemia”: postprandial adrenergic symptoms with concomitant normal plasma glucose levels.
Book Source Details
- Book Title: A Pocket Manual of Differential Diagnosis
- Author(s): Stephen N. Adler, Dianne B. Gasbarra
- Year of Publication: 1999
- Copyright Details: A Pocket Manual of Differential Diagnosis, Copyright © 1999 Lippincott Williams & Wilkins.
Other Book Chapters Related to Hypoglycemia
Read excerpts from these other book chapters related to Hypoglycemia:
Copyright Details: A Pocket Manual of Differential Diagnosis, Copyright © 2008 Williams & Wilkins.
More About Causes of Hypoglycemia
» Next page: Hypoglycemia (Professional Guide to Diseases (Eighth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
