Broadening perspectives on hypoglycemia diagnosis in non-diabetic patients

A 51-year-old man with a past medical history of chronic alcoholism was admitted for a planned fasting test due to suspected hypoglycemia. Despite previous evaluations by cardiology and neurology revealing no evident etiology, his syncopal episodes were suspected be associated with inconsistent hypoglycemic episodes. During his hospital admission, the patient experienced several syncopal episodes with associated seizures, which, at the time, were not related to hypoglycemia. This led to further investigation, including the exclusion of other causes, such as a possible autonomic dysfunction. Neurology consequently expanded the assessment, identifying subtle signs of mild parkinsonism and symptoms suggestive of a REM sleep disorder, which shifted the diagnostic suspicion. This case underscores the importance of considering other clinical conditions when evaluating hypoglycemia, especially when classic symptoms are absent or inconsistently presented, and an endocrinological origin has been ruled out.