Diagnostic Considerations
Many physicians may fail to recognize hypoglycemia in affected patients, either initially or over the long term. Clinical symptoms of hypoglycemia may be subtle or overt, but they are not specific to hypoglycemia and are frequently attributed to other disorders. This is particularly true if the patient has had another neurologic insult, such as head trauma or hypoxia.
Plasma glucose levels should be tested in any patient who presents with neurologic deficits at the time the deficits are present. This may prevent prolonged, inappropriate, ineffective anticonvulsant therapy in children who initially present with seizures. Failure to recognize hypoglycemia can lead to permanent impairments or death if the condition is not treated. Hypoglycemia has been reported in individuals who were thought to be comatose secondary to head trauma.
A second area of concern involves children with hypoglycemia due to abuse or Münchausen syndrome by proxy. The possibility of exogenous insulin administration must be considered and, if found, reported to the appropriate authorities.
Conditions to consider in the differential diagnosis of hypoglycemia include the following:
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Adrenal insufficiency - Primary adrenal disease (Addison disease); ACTH deficiency
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Growth hormone deficiency
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Hyperinsulinism - Endogenous (genetic, beta-cell tumor); exogenous insulin administration
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Medium chain acyl-CoA dehydrogenase deficiencies
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Sepsis
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Hyperthyroidism
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Hypopituitarism
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Glycogen storage diseases - Types 0, I, IV, V, and VI
Differential Diagnoses
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Normal hypoglycemic counterregulation.
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Interpretation of the critical sample.
