Mrs. Drumkl is brought in emergency following loss of consciousness after behaving very oddly in the supermarket. Her capillary glucose level is 1.8 mmol/L. Her husband tells you she has been having similar episodes at home for about 3 months now, relieved by eating.
List 5 causes in your differential.
- Drugs, including alcohol
- Critical illness:
- Renal or cardiac failure
- Cortisol/GH deficiency
- Nonislet cell tumors producing IGF-1 or IGF-2
- Endogenous hyperinsulinism:
- Noninsulinoma pancratogenous hypoglycemia
- Post-gastric bypass surgery
- Antibodies to insulin and insulin receptor
- Accidental, surreptitious, or malicious hypoglycemia