ABIM Exam Review Practice Question of the Week: Causes of Hypoglycemia

Here’s a practice question directly from Knowmedge’s Internal Medicine Board (ABIM) Exam QVault.


All of the following conditions or scenarios can result in hypoglycemia except:


A. Condition causing hyperpigmentation, low blood pressure, muscle wasting, and hyperkalemia

B. Elderly patient with urosepsis and poor oral intake

C. Condition that is screened with an elevated IGF-1 level

D. Condition that is screened with an elevated carbohydrate-free transferrin level

E. Profound hepatic dysfunction





Symptoms of hypoglycemia include confusion, stupor, coma and even death. In response to the low blood sugar, the patient can become tachycardic, sweat profusely, feel nauseous or experience palpitations. There are numerous causes of hypoglycemia. The most common cause is the use of anti-diabetic drugs such as insulin, sulfonylureas, or meglitinides.


Hypoglycemia in patients without diabetes is less commonly encountered but can result from:

  • Excessive alcohol consumption
  • Renal failure
  • Hepatic failure
  • Insulinoma
  • Infection
  • Neoplasm
  • Pituitary failure


Let’s go through the answer choices to find the scenario least likely to be associated with hypoglycemia.


Choice A (Condition causing hyperpigmentation, low blood pressure, muscle wasting, and hyperkalemia) is describing Addison’s disease or primary adrenal insufficiency. With primary adrenal insufficiency, cortisol levels are low, which could lead to hypoglycemia. Because cortisol levels are low in primary adrenal insufficiency, ACTH levels are high in a negative feedback mechanism. Elevated ACTH levels leads to hyperpigmentation.


Choice B (Elderly patient with urosepsis and poor oral intake) is a possible scenario for hypoglycemia. Lack of nutrition, especially in elderly patients who are septic, can cause low blood sugars.


Choice C (Condition screened with an elevated IGF-1 level) is describing a condition that will not lead to hypoglycemia. Elevated insulin growth factor (IGF-1) levels is a positive screening test for acromegaly. Acromegaly can be confirmed by giving a glucose load and the patient’s failure to suppress growth hormone will diagnose acromegaly. Patients who have growth hormone excess tend to have hyperglycemia, not hypoglycemia.


Choice D (Associated with elevated carbohydrate free transferrin level for screening) is describing chronic alcohol abuse, which can lead to hypoglycemia.


Choice E can also cause hypoglycemia. With profound hepatic dysfunction, glucose stores can be depleted due to impaired gluconeogenesis.


You can see all the previous ABIM Exam Review Questions of the Week at the Knowmedge Blog. You can find also additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.

Got something to add?

Please log In or register for a free account to write a comment.