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

Workup

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