Causes of hypoglycemia
1470016
217338239
2008-06-05T16:25:05Z
Edward
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link [[Cachexia]]
{{Unreferenced|date=December 2007}}
{{expert|date=December 2007}}
{{Notability|date=December 2007}}
This list of causes of [[hypoglycemia]] is separated from the main article because of its length. Despite its length, it is not exhaustive, as new causes are reported regularly in the medical literature. In many individual instances of hypoglycemia, more than one contributing factor may be identifiable. In this list are some factors not usually sufficient to cause hypoglycemia by themselves. Some of these causes are represented by single case reports.
=== Causes of Transient Neonatal Hypoglycemia ===
*[[Prematurity]]
*[[Intrauterine growth retardation]]
**Smaller of [[twins]]
*Severe [[infant respiratory distress syndrome]]
*Maternal [[toxemia]]
*[[Perinatal asphyxia]]
*Critical illness
=== Starvation, Inadequate Intake Or Absorption ===
*[[Fasting]], e.g. preoperative
*Severe malnutrition
*[[Kwashiorkor]]
*[[Anorexia nervosa]]
*[[Pyloric stenosis]]
*[[Vitamin B6]] (pyridoxine) deficiency
*[[Biotin]] deficiency
*[[Hypomagnesemia]]
*[[Diarrhea]]
*[[Renal glycosuria]]
*Combined intestinal [[monosaccharide]] transport defect
=== Major Organ Failure & Critical Illness ===
*[[Congestive heart failure]]
*Cyanotic [[congenital heart disease]]
*[[Renal failure]], especially chronic
**[[Dialysis]]
*Central nervous system disorders
**[[Head trauma]]
**[[Stroke]]
**Severe [[encephalopathy|encephalopathies]]
**Hypothalamic [[brain tumor|tumor]]
*Liver disorders
**Severe acute [[hepatitis]] due to infection or toxins
**Chronic liver failure
**[[Reye's syndrome]]
**[[HELLP syndrome]] ([[hemolysis]], elevated [[liver enzyme]]s, [[thrombocytopenia]])
*Chronic [[pancreatitis]]
*[[Sepsis]]
*[[Hypothermia]]
*[[Malignant hyperthermia]]
=== Extrapancreatic Tumors ===
*Mechanisms
**Increased utilization by large or active tumor
**[[Cachexia]] and depletion of [[glycogen]] reserves
**[[Insulin-like growth factor|Insulin-like peptides]], especially [[Insulin-like growth factor 2|IGF-II]] ([[Doege-Potter syndrome]])
**Inhibited hepatic [[gluconeogenesis]] or [[glycogenolysis]]
**Blunted counterregulatory hormone responses
**Autoimmune (see below)
*Tumors associated with hypoglycemia
**Benign and malignant [[mesothelioma]]
**[[Neurofibroma]]
**[[Fibrosarcoma]]
**[[Rhabdomyosarcoma]]
**[[Leiomyosarcoma]]
**[[Liposarcoma]]
**[[Sarcomatous dysembryoma]]
**[[Reticulum cell sarcoma]]
**[[Hemangiopericytoma]]
**[[Spindle cell sarcoma]]
**[[Pseudomyxoma peritonei]] (Rosenfeld syndrome)
**[[Hepatoma]] (Nadler Wolfer Elliott syndrome)
**[[Adrenal carcinoma]] (Anderson syndrome)
**Non-islet [[pancreatic carcinoma]]
**[[Hypernephroma]]
**[[Adenocarcinoma]]s of [[prostate cancer|prostate]], [[colon cancer|colon]], bile duct, [[breast cancer|breast]], [[stomach cancer|stomach]]
**Simple fibroma
**[[Leukemia]]
**[[Lymphoma]]s and [[Hodgkin's disease]]
**[[Multiple myeloma]]
**[[Wilms' tumor]]
**[[Apudoma]]
**[[Carcinoid tumor]]s
**[[Pheochromocytoma]] (especially after removal)
**[[Melanoma]]
**[[Teratoma]]
**[[Neuroblastoma]]
**[[Paraganglioma]]
=== Hyperinsulinism ===
*Hypoglycemia due to endogenous insulin
**[[Congenital hyperinsulinism]]
***Transient neonatal hyperinsulinism
****Due to maternal factors
*****Maternal diabetes
*****[[Erythroblastosis fetalis]]
*****Excessive intravenous glucose during labor
*****Maternal [[sulfonylurea]]
*****Sympathomimetic [[tocolytic agent]]s (e.g. [[ritodrine]])
****Due to infant factors
*****[[Intrauterine growth retardation]]
*****[[Perinatal asphyxia]]
*****Idiopathic transient hyperinsulinism
****Iatrogenic
*****Malposition of [[umbilical catheter]]
***Focal congenital hyperinsulinism
****Paternal SUR1 [[mutation]] with clonal [[loss of heterozygosity]] of 11p15
****Paternal Kir6.2 mutation with clonal loss of heterozygosity of 11p15
***Diffuse congenital hyperinsulinism
****[[Autosomal recessive]] forms
*****SUR1 mutations
*****Kir6.2 mutations
****[[Autosomal dominant]] forms
*****[[Glucokinase]] gain-of-function mutations
*****[[hyperammonemia|Hyperammonemic]] hyperinsulinism (glutamate dehydrogenase gain-of-function mutations)
*****Loss of heterozygosity of 11p15 ([[Beckwith-Wiedemann syndrome]])
***[[Donohue syndrome]] (leprechaunism)
**Acquired tumors and hyperplasias of pancreatic beta cells
***[[Islet cell adenoma]]
***[[Islet cell carcinoma]]
***[[Multiple endocrine adenomatosis]] syndrome
***Pluriglandular syndrome of islet, pituitary, parathyroid hyperplasia
**[[Autoimmune insulin syndrome]]
**[[Reactive hypoglycemia]] (postprandial hypoglycemia syndrome)
**[[Dumping syndrome]]
*Drug induced hyperinsulinism
**[[Oral hypoglycemic agent]]s, especially [[Sulfonylurea]]s
***Treatment of diabetes
***Treatment of [[diabetes insipidus]]
***Ingestion by child
**[[Aspirin]] overdose
**[[Acetaminophen]] overdose
**[[Pentamidine]]
**[[Quinine]]
**[[Disopyramide]]
**[[Bordetella pertussis]] vaccine or infection
*Hypoglycemia due to exogenous (injected) insulin
**Insulin self-injected for treatment of [[diabetes]]
***Excessive insulin dosage or accelerated absorption
***Excessive activity
***Inadequate food or delayed or decreased absorption
***[[alcoholic beverage|Alcohol]]
***Drugs which contribute synergistically
***Development of concurrent disease
***Acquired endocrinopathies
***Renal, cardiac or liver failure
**Factitious & malicious insulin injection
***Insulin self-injected surreptitiously (e.g., [[Munchausen syndrome]])
***[[Munchausen]] by proxy
**Insulin tolerance test for [[pituitary]] or [[autonomic nervous system|adrenergic]] response assessment
**Treatment of [[hyperkalemia]]
**Insulin potentiation treatment ([[cancer quackery]])
**Insulin-induced coma for [[clinical depression|depression]] or [[psychosis]] treatment (insulin shock)
=== Hormone Deficiencies ===
*[[Cortisol]]
**[[Addison's disease]] (acquired adrenal destruction)
**[[ACTH]] deficiency
**ACTH unresponsiveness
**[[Congenital adrenal hypoplasia]]
**[[Congenital adrenal hyperplasia]]
*[[Growth hormone]]
**Isolated [[growth hormone deficiency]]
**Laron dwarfism (GH unresponsiveness)
*[[Epinephrine]] and [[catecholamine]]s
**Adrenomedullary unresponsiveness
*[[Glucagon]]
*Combined deficiencies
**Congenital [[hypopituitarism]] (various causes)
**Psychosocial deprivation syndrome (hypothalamic)
**[[Thyroid]] hormone (depresses GH and ACTH)
=== Metabolic Defects ===
*Defective glycogenolysis or glycogen accumulation
**Glucose-6-phosphatase deficiency ([[glycogen storage disease|glycogenosis type I]], von Gierke dis)
**Pseudoglycogenosis type I
**[[Amylo-1,6-glucosidase]] (debrancher) deficiency ([[glycogenosis type III]])
**Hepatic [[phosphorylase]] deficiency ([[glycogenosis type VI]])
**Hepatic [[phosphorylase kinase]] deficiency ([[glycogenosis type IXb]])
**[[Glycogen synthase]] deficiency ([[glycogenosis type 0]])
*[[Galactose-1-phosphate uridyl transferase]] deficiency ([[galactosemia]])
*Defects of gluconeogenesis or substrate supply
**[[Fructose-1,6-diphosphatase deficiency]]
**[[Isovaleric acidemia]]
**Hypo[[alanine]]mia
**[[Phosphoenolpyruvate carboxykinase]] deficiency
**[[Pyruvate carboxylase]] deficiency ([[Leigh syndrome]])
**[[Fructose-1-phosphate aldolase deficiency]]
*Defects of mitochondrial beta-oxidation and fatty acid metabolism
**Systemic [[carnitine]] deficiencies
***[[Enzyme deficiencies]]
***[[Carnitine palmitoyltransferase I]]
***[[Carnitine palmitoyltransferase II]]
***[[Carnitine acyltransferase]]
**[[Butyryl CoA dehydrogenase]]
**[[Hydroxymethylglutaryl CoA lyase]]
**[[Methylcrotonyl CoA carboxylase]]
**[[Medium chain acyl CoA dehydrogenase]]
**[[Short chain acyl CoA dehydrogenase]]
**[[Long chain acyl CoA dehydrogenase]]
**[[Multiple acyl CoA dehydrogenase]] (glutaric [[organic aciduria|aciduria]] type II)
**[[Long-chain 3-hydroxyacyl-CoA dehydrogenase]]
**[[Short-chain 3-hydroxyacyl CoA dehydrogenase]]
**[[Carnitine/acylcarnitine translocase]]
*[[Enoyl CoA hydratase]]
*[[Ketothiolase]]
*[[Succinyl CoA:acetoacetate transferase]]
*Defects of [[amino acid]] metabolism
**[[Maple syrup urine disease]]
**[[Methylmalonic acidemia]]
**[[hydroxy-methylglutaric [[aciduria]]]]
**[[Tyrosinosis]]
**[[Phenylketonuria]]
**[[Propionic acidemia]]
*Miscellaneous metabolic defects
**Defective type I glucose transporter in brain
**[[Methylglutaconic aciduria]]
**[[Sucrosuria]]
**[[Glycerol]] intolerance
**Rare variants of [[galactose]] intolerance
**Other rare or poorly defined congenital metabolic defects
=== Drugs And Toxic substances ===
*Insulin, antidiabetic agents (see above)
*Drugs associated with hypoglycemia alone
**[[Ethyl alcohol|Ethanol]]
**[[Beta blockers]], e.g. [[propranolol]]
**Salicylates
**[[Acetaminophen]]
**[[Acetazolamide]]
**[[Aluminium hydroxide]]
**[[Chloroquine]]
**[[Chlorpromazine]]
**[[Cimetidine]], [[ranitidine]]
**[[Diphenhydramine]], other [[antihistamine]]s
**[[Propoxyphene]]
**[[Disopyramide]]
**[[Doxepin]]
**[[Golytely]] (in distal intestinal obstruction syndrome of [[cystic fibrosis]])
**[[Imipramine]]
**[[Indometacin]]
**[[Isoxsuprine]]
**[[Insulin-like growth factor 1]]
**[[Lidocaine]]
**[[Lithium salt|Lithium]]
**Pentamidine
**[[Propranolol]], nadolol, [[labetalol]], metoprolol
**Orphenadrine
**Oxytetracycline
**[[Quinine]], quinidine
**Perhexiline
**Ritodrine
**[[Haloperidol]]
**Chelating agents (BAL and EDTA)
**THAM
**Colchicine
**Para amino benzoic acid, para-amino salicylic acid
**Cholestyramine added during glucocorticoid therapy (reduces absorption)
*Drugs which lower glucose in diabetics
**[[Enalapril]] and [[captopril]]
**[[Coumarin]]
**[[Phenylbutazone]]
**[[Antihistamine]]s
**Sulfa antibiotics, including SMX/TMP (especially in renal failure)
**[[Monoamine oxidase inhibitor]]s
**Medicines not available in U.S.
***Azapropazone, buformin, carbutamide, cibenzoline, cycloheptolamide, glibornuride, [[gliclazide]], mebanazine, metahexamide, perhexiline, sulphadimidine, sulphaphenazole, Nigerian cow urine medicine
*Environmental toxins
**Amanita phalloides toxin
**Abractylis gummifera (Mediterranean plant)
**Hypoglycin from unripe [[Ackee]] fruit (Jamaican vomiting illness)
**Parathion
**Vacor rat poison
=== Idiopathic And Miscellaneous ===
*[[Ketotic hypoglycemia]]
**Identifiable hormone and enzyme deficiencies
*Idiopathic
**Idiopathic hypoglycemias, etiologies undetermined
**Autoimmune
**Antibodies to insulin
**Antibodies to insulin receptor
**Stimulating antibodies to islet cells
**[[Thyrotoxicosis]] (extremely rare)
**Infection
***[[Mumps]]
***[[Varicella]]
***[[Pertussis]]
***[[Measles]]
***[[Malaria]]
*Extreme exercise
*Artifactual
**In vitro glucose consumption after blood drawing
**Leukemic WBC's may consume glucose in vitro
**[[Polycythemia]] of infancy (RBCs consume glucose in vitro)
**Inaccuracies of blood drop strips
**Inherent variation inaccuracy at low end
**Inadequate drop
**Excessive wiping
**Short time interval
=== Reactive, Functional, Postprandial, Etc. ===
*Prediabetes (both categories controversial & may not be valid)
**Juvenile diabetes (rare, anecdotal reports)
**Adult onset diabetes (in early stages)
*After intravenous glucose load
*Abrupt discontinuation of parenteral nutrition or i.v. glucose
*After exchange transfusion with ACD preserved blood in neonate
*Alimentary (rapid jejunal emptying with exaggerated insulin response)
*Post fundoplication for gastroesophageal reflux
*Post gastrectomy [[dumping syndrome]]
*Short bowel syndrome
*Idiopathic gastrointestinal motility disturbance
*Alternate day growth hormone therapy
*Idiopathic [[reactive hypoglycemia|reactive or postprandial hypoglycemia]] (hypoglycemia documented at time of symptoms: rare)
*[[Idiopathic postprandial syndrome]] (hypoglycemia never documented: common)
[[Category:Metabolic disorders|Hypoglycemia, Causes of]]