Clinical Note

Hypoglycemia may be the presenting symptom in patients suffering from a variety of ailments and may be the principal symptom of hypopi-tuitarism that results in the combined deficiency of GH and ACTH, or of either of these hormones alone. Similarly, hypoglycemia is a prominent symptom of adrenal cortical failure (Addison's disease). Hypoglycemia due to a glucagon deficiency is not seen, presumably because of redundancy with sympathetic mechanisms for rapidly increasing glucose production. Not surprisingly, severe hepatic damage caused by hepatitis or a variety of hepatic toxins may produce hypoglycemia in patients with inadequate food intake. Carnitine deficiency, which results in impaired fatty acid transport into mitochondria also results in hypoglycemia during fasting. Plasma concentrations of insulin are appropriately low in all of these cases of hypo-glycemia. Because the restraining effect of insulin on fatty acid mobilization is lacking, ketonemia is a prominent feature of all of these hypogly-cemias except that resulting from carnitine deficiency.

that govern storage of fuel as glycogen, protein, or triglycerides.

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