Hypoglycemia is an abnormally low blood glucose level. Reactive hypoglycemia occurs in response to a meal, specific nutrients, or drugs. It may occur within 2-3 hours after a meal, or later. It may also be seen after gastrointestinal surgery (in association with dumping syndrome in some patients).
Spontaneous (fasting) hypoglycemia may be associated with a primary condition, e.g., hypopituitarism, Addison's disease, myxedema, or in disorders related to liver malfunction, and renal failure. If hypoglycemia presents as a primary manifestation, other disorders to consider include hyperinsulinism and extrapancreatic tumors.
Causes of reactive hypoglycemia include: meals high in refined carbohydrates and certain nutrients, (e.g., fructose, galactose, leucine). Drugs (e.g., sulfonylureas, salicylates) or alcohol can cause excess glucose utilization or deficient glucose production. Hypoglycemia can also be caused by surreptitious drug use - injection of insulin or taking oral hypoglycemics. Hypoglycemia may be caused by gastrointestinal surgery.
Causes of spontaneous hypoglycemia include: hepatic disease; pancreatic islet cell tumor or extrapancreatic tumor; exercise; fever; pregnancy; renal glycosuria; ketotic hypoglycemia of childhood; adrenal insufficiency; hypopituitarism; or enzyme deficiency.
The development of hypoglycemia is a characteristic finding related to growth hormone deficiency.
Lab tests are best ordered while symptomatic, and include measurement of blood and plasma glucose; C-peptide; liver studies; serum insulin; and cortisol. An abdominal CT or ultrasound may be ordered to rule out an abdominal tumor.
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