Glucose Intolerance Differential Diagnoses

Updated: Sep 22, 2017
  • Author: Samuel T Olatunbosun, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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DDx

Diagnostic Considerations

Genetic defects of beta-cell function include the following:

  • Mutation on chromosome 12, the hepatocyte nuclear factor (HNF-1) alpha - MODY3
  • Mutation on chromosome 7p, the glucokinase gene - MODY2
  • Mutation on chromosome 20, HNF-4 alpha - MODY1
  • Point mutations in mitochondrial DNA

Defects in insulin action include the following:

  • Structure and function of insulin receptor: postreceptor signal transduction pathways
  • Type A insulin resistance
  • Leprechaunism
  • Rabson-Mendenhall syndrome
  • Lipoatrophic diabetes

Diseases of the exocrine pancreas include the following:

  • Pancreatitis
  • Trauma
  • Infection
  • Pancreatectomy
  • Pancreatic cancer
  • Cystic fibrosis
  • Hemochromatosis
  • Fibrocalculous pancreatopathy

Endocrine diseases associated with excess production of insulin antagonists include the following:

  • Acromegaly
  • Cushing syndrome
  • Glucagonoma
  • Pheochromocytoma
  • Hyperthyroidism
  • Somatostatinoma
  • Aldosteronoma

Drugs or chemical agents with adverse effects on glucose tolerance include the following:

  • Thiazides
  • Diazoxide
  • Glucocorticoids
  • Calcineurin inhibitors, such as cyclosporine and tacrolimus
  • Oral contraceptives
  • Beta-adrenergic agonists
  • Nicotinic acid
  • Thyroid hormone
  • Pentamidine
  • Alpha interferon
  • Atypical antipsychotics, especially clozapine and olanzapine
  • Antiretroviral drugs
  • Vacor

Infections associated with beta-cell destruction include the following:

  • Rubella
  • Coxsackievirus B
  • Mumps
  • Cytomegalovirus
  • Adenovirus

Genetic syndromes that predispose an individual to impaired glucose tolerance include the following:

  • Down syndrome
  • Klinefelter syndrome
  • Turner syndrome
  • Wolfram syndrome
  • Friedreich ataxia

Pregnancy can be associated with gestational diabetes mellitus, and the risk of diabetes increases with parity.

Immune-mediated causes of impaired glucose tolerance include stiff person syndrome and anti-insulin receptor abnormalities. Other causes of glucose intolerance are liver disease (as in cirrhosis) and renal failure.

Differential Diagnoses