Regulation and clinical manifestations of gluconeogenesis dysfunction

The liver is the principal organ responsible for maintaining systemic glucose homeostasis through the integrated regulation of gluconeogenesis, glycogenolysis, glycogenesis, and glycolysis. As fasting progresses and hepatic glycogen stores decline, gluconeogenesis becomes the dominant source of endogenous glucose production required to preserve euglycemia. This review summarizes the regulation of gluconeogenesis and discusses the clinical manifestations, diagnostic implications, and therapeutic relevance of gluconeogenic dysfunction across diverse disease states.