The main clinical manifestation of an insulinoma is fasting hypoglycemia. Symptoms are insidious and can mimick various central nervous system disorders, like epilepsy and psychiatric disorders [6]. The presentation is characterized by the Whipple triad in many patients which includes:

• Presence of symptoms and signs of hypoglycemia.
• Concomitant low blood sugar. 
• Reversibility of symptoms by glucose administration.

Adrenergic symptoms resulting from the catecholaminergic response include weakness, anxiety, nausea, hunger, sweating, tremor, tachycardia, and palpitations. Neuroglycopenic symtoms oberserved in patients are headache, confusion, lethargy, diplopia, blurred vision, amnesia, seizures and in more severe cases unconsciousness. The symptoms can be aggravated by alcohol intake, exercise, and certain medications.

• Weakness

  The symptoms include faintness, weakness, trembling, awareness of the heartbeat (palpitations), sweating, nervousness, and profound hunger. [msdmanuals.com]

  Adrenergic symptoms resulting from the catecholaminergic response include weakness, anxiety, nausea, hunger, sweating, tremor, tachycardia, and palpitations. [symptoma.com]

• Weight Gain

  The child had a favorable evolution in the clinical follow-up, presenting with weight gain and progressive remission to complete disappearance of most symptoms-except for the mental impairments. [ncbi.nlm.nih.gov]

  References: [2] [3] [4] [5] [6] Clinical features Clinical features of hypoglycemia Relief of symptoms after administering glucose (See also Whipple's triad ) Weight gain Symptoms characteristic of other endocrine neoplasias may occur. [amboss.com]

  Symptoms may include: Anxiety, behavior changes, or confusion Clouded vision Loss of consciousness or coma Convulsions or tremor Dizziness or headache Hunger or weight gain Fast heart rate or palpitations Sweating Exams and Tests After fasting, your blood [owensborohealthse3.adam.com]

  Some patients (18%) experience weight gain. [cancertherapyadvisor.com]

• Unconsciousness

  A 53-year-old woman fell unconscious during postprandial exercises. [ncbi.nlm.nih.gov]

  You might have fits (seizures) and become unconscious (coma). Weakness and tiredness You might feel very tired a lot of the time. Headaches Headaches are a common symptom of many illnesses. [cancerresearchuk.org]

  Neuroglycopenic symtoms oberserved in patients are headache, confusion, lethargy, diplopia, blurred vision, amnesia, seizures and in more severe cases unconsciousness. [symptoma.com]

  Many say that the ferret will begin to respond in 5 or 10 minutes, and in some instances, this is true; however I have not found this to be the case if the ferret is unconscious. Many times it has taken an hour or more before the ferret responds. [miamiferret.org]

  CASE REPORT A 75 year old woman presented, unconscious, after a collapse at home. An initial diagnosis of a cerebrovascular accident was made. However, the capillary blood glucose concentration was measured at 1.1 mmol/l. [pmj.bmj.com]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 12, 2019 [patientslikeme.com]

  Case Presentation In this report, we present a 15-year-old female who visited her primary care provider complaining of intermittent episodes of altered mental status including fatigue, irritability, and poor concentration. [ijpeonline.biomedcentral.com]

  History revealed that she did, indeed, have severe fatigue. She did not complain of syncope, palpitations, or diaphoresis. [clinical.diabetesjournals.org]

  Insulinoma is one of several pNET types, and pNETs have common symptoms, like fatigue — feeling extremely tired day after day — and diarrhea, that you might have to manage throughout your treatment. Try to get as much rest as you can. [my.clevelandclinic.org]

  […] level in blood, such as sweating, dizziness/confusion, blurring of vision, and even loss of consciousness Nausea and vomiting Abdominal pain, back pain Loss of appetite, weight loss Diarrhea, indigestion Yellowing of skin (jaundice) Dark-colored urine Fatigue [dovemed.com]

• Pallor

  This can cause symptoms such as: • sweating • a pale appearance (pallor) • racing of the heartbeat • feelings of anxiety • irritability or confusion • double vision • unusual behaviour • blackouts or seizures These episodes can occur particularly when [yourhormones.info]

  The patient reported occasional episodes of weakness, sweating, pallor, tremor, confusion, paresthesias, and visual blurring in the previous year. He denied taking any drugs. Cardiovascular, respiratory, and neurological examinations were normal. [journals.lww.com]

• Nausea

  They produce the typical symptoms of low blood glucose levels: Excessive hunger Shaking Sweating Palpitations Ventricular tachycardia Nausea Dizziness The typical symptoms correspond to the so-called Whipple triad. [flexikon.doccheck.com]

  Symptoms resulting from the catecholaminergic response to hypoglycemia (i.e. tremulousness, palpitations, tachycardia, sweating, hunger, anxiety, nausea) are not as common. Sudden weight gain is sometimes seen. [en.wikipedia.org]

  Adrenergic symptoms resulting from the catecholaminergic response include weakness, anxiety, nausea, hunger, sweating, tremor, tachycardia, and palpitations. [symptoma.com]

  Nausea, ptyalism, vomiting or gagging, or pawing at the mouth may also be described. [mspca.org]

• Vomiting

  Nausea, ptyalism, vomiting or gagging, or pawing at the mouth may also be described. [mspca.org]

  Ketotic hypoglycaemia presents with symptoms of hypoglycaemia (eg sweating, irritable, confused) and also nausea and vomiting. Severe hypoglycaemia may cause fainting, seizures and loss of consciousness. [patient.info]

  You’re vomiting a lot or you have persistent diarrhea. What questions should I ask my healthcare provider? You may be surprised and a little alarmed to learn you have a rare disease. [my.clevelandclinic.org]

• Abdominal Pain

  The most common symptom associated with nonfunctioning pNENs is abdominal pain and, in some cases, an abdominal mass may be present. [rarediseases.org]

  The signs and symptoms may include the following: Symptoms of low glucose level in blood, such as sweating, dizziness/confusion, blurring of vision, and even loss of consciousness Nausea and vomiting Abdominal pain, back pain Loss of appetite, weight [dovemed.com]

  Symptoms related to the tumor and its factors may be intermittent and vague, but the most common presentation is periodic abdominal pain sometimes accompanied by malignant carcinoid syndrome, characterized by flushing of the face, severe diarrhea, and [pancreatica.org]

  None of the patients had abdominal pain or jaundice. Unintentional weight gain was found in 95 cases (48%). None of the patients in this cohort had previous negative laparotomies for insulinomas. [jamanetwork.com]

  pain, headache and rash. 14-16 In order to reduce nausea, patients are advised to take diazoxide with a meal. 13 Palpitation and renal malfunction have also been noted. 8,9 Any adverse effects that occur are generally not troublesome and the potential [hormones.gr]

• Increased Appetite

  She denied having seizures and diabetes but he noticed increased appetite over the past year. She had no family history of diabetes, thyroid or pituitary disease. [oatext.com]

• Palpitations

  During the clinical course of pancreatic neuroendocrine tumor, she had experienced palpitations, cold sweats and faintness between meals that indicated her tumors had attained the characteristics of an insulinoma, and her quality of life was impacted [ncbi.nlm.nih.gov]

  They produce the typical symptoms of low blood glucose levels: Excessive hunger Shaking Sweating Palpitations Ventricular tachycardia Nausea Dizziness The typical symptoms correspond to the so-called Whipple triad. [flexikon.doccheck.com]

  Palpitations You may feel that your heart is racing. This can make you feel dizzy, breathless and lightheaded. Whipple’s triad The Whipple’s triad is a collection of symptoms that help doctors diagnose an insulinoma. [cancerresearchuk.org]

• Tachycardia

  They produce the typical symptoms of low blood glucose levels: Excessive hunger Shaking Sweating Palpitations Ventricular tachycardia Nausea Dizziness The typical symptoms correspond to the so-called Whipple triad. [flexikon.doccheck.com]

  […] with MEN1), small ( Insulinoma patients characteristically present with symptoms of recurrent hypoglycemia, especially neuroglucopenic symptoms (e.g., confusion, altered consciousness, visual changes) and symptoms due to sympathetic overdrive (e.g., tachycardia [cancertherapyadvisor.com]

  Symptoms resulting from the catecholaminergic response to hypoglycemia (i.e. tremulousness, palpitations, tachycardia, sweating, hunger, anxiety, nausea) are not as common. Sudden weight gain is sometimes seen. [en.wikipedia.org]

  Adrenergic symptoms resulting from the catecholaminergic response include weakness, anxiety, nausea, hunger, sweating, tremor, tachycardia, and palpitations. [symptoma.com]

• Hypertension

  The possible etiology of hypertension induced by an insulinoma is catecholamine release in response to hypoglycemia, which may cause acute hypertension through activation of the sympatho-adrenal system. [ncbi.nlm.nih.gov]

  She had a history of hypertension, but not diabetes (HbA1c range, 4.8%-5.6%), liver or kidney disease. Her family history was significant for diabetes in her mother. She had a prior smoking history, but no alcohol or substance use. [healio.com]

  She was also a known hypertensive on regular medications. Her vital signs were within normal limits. Auscultation of the chest revealed bilateral crepitations. Rest of the systemic examination was normal. [apicareonline.com]

  Affected individuals may have a round, moon-shaped face, thin, fragile skin that bruises easily, high blood pressure (hypertension), generalized muscle weakness, behavioral changes, facial flushing, and weakened bones that fracture easily (osteoporosis [rarediseases.org]

• Hypotension

  […] include PPHrPomas, which secrete parathyroid hormone-related protein and may cause hyperparathyroidism; calcitoninomas, which secrete calcitonin and can cause watery diarrhea and facial flushing; and neurotensinomas, which can cause low blood pressure (hypotension [rarediseases.org]

• Sweating

  Sweating and tremors You might have a sudden onset of sweating and feel like you are shaking or having tremors. Palpitations You may feel that your heart is racing. This can make you feel dizzy, breathless and lightheaded. [cancerresearchuk.org]

  Abstract A 45-year-old female who presented with loss of consciousness and a cold sweat was found to have a pancreatic tumor and multiple liver metastases. [ncbi.nlm.nih.gov]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Pancreatic tumor Blood glucose ≤40 mg/dL without other etiology Hypoglycemia symptoms without other etiology Confusion/altered consciousness Sweating/diaphoresis Headache Visual disturbance [arupconsult.com]

• Blurred Vision

  Symptoms include double vision, blurred vision, headache, lethargy, confusion, weakness, sweating, hunger, tremors, tremulousness, anxiety, rapid heart rate and in severe cases, seizures and coma. [symptoma.com]

  […] and blurred vision. [cancerresearchuk.org]

  This includes tiredness, weakness, tremors, recurrent headache, diplopia (when a single object is perceived as two images), and blurred vision. [knowcancer.com]

  Symptoms of insulinoma The symptoms of insulinoma are largely similar to the symptoms of hypoglycemia, which include: Blurred vision Anxiety Sweating Trouble concentration and Weakness These are all typically mild symptoms caused by changes in insulin [diabetes.co.uk]

• Diplopia

  This includes tiredness, weakness, tremors, recurrent headache, diplopia (when a single object is perceived as two images), and blurred vision. [knowcancer.com]

  These include recurrent headache, lethargy, diplopia, and blurred vision, particularly with exercise or fasting. Severe hypoglycemia may result in seizures, coma, and permanent neurological damage. [en.wikipedia.org]

  Neuroglycopenic symtoms oberserved in patients are headache, confusion, lethargy, diplopia, blurred vision, amnesia, seizures and in more severe cases unconsciousness. [symptoma.com]

  Neuroglycopenia Adrenergic Diplopia (double vision) Weakness, warmth Blurred vision Sweating Confusion, Abnormal behavior Hunger Amnesia to Symptoms, Events Tremor Seizures Palpations (heart pounding) Loss of consciousness Tachycardia (heart racing) Coma [endocrinediseases.org]

  It may also present with transient hemiplegia, hypothermia or hyperthermia, convulsions, diplopia and strabismus [ 9 ]. If untreated, it can progress to stupor, coma and, exceptionally, death. [patient.info]

• Hunger

  CASE REPORT: We report the case of sporadic insulinoma in an exceptionally very young 10-year-old boy who presented with a 1-month history of episodic tremulousness, diaphoresis, increased hunger, confusion and fainting. [ncbi.nlm.nih.gov]

  Hypoglycemia may be mild, leading to symptoms such as anxiety and hunger. Or it can be severe, leading to seizures, coma, and even death. Insulinomas are very rare tumors. They usually occur as single, small tumors. [owensborohealthse3.adam.com]

  Symptoms: sweating tremor rapid heart rate anxiety hunger dizziness headache clouding vision confusion behavioral changes convulsions loss of consciousness Signs and tests: The person's blood may be tested while fasting (not eating). [uclahealth.org]

  They produce the typical symptoms of low blood glucose levels: Excessive hunger Shaking Sweating Palpitations Ventricular tachycardia Nausea Dizziness The typical symptoms correspond to the so-called Whipple triad. [flexikon.doccheck.com]

  Adrenergic symptoms resulting from the catecholaminergic response include weakness, anxiety, nausea, hunger, sweating, tremor, tachycardia, and palpitations. [symptoma.com]

• Abnormal Behavior

  We report a case of insulinoma in a 55 years old female who presented with episodes of abnormal behavior and altered sensorium. [ncbi.nlm.nih.gov]

  Neuroglycopenia Adrenergic Diplopia (double vision) Weakness, warmth Blurred vision Sweating Confusion, Abnormal behavior Hunger Amnesia to Symptoms, Events Tremor Seizures Palpations (heart pounding) Loss of consciousness Tachycardia (heart racing) Coma [endocrinediseases.org]

  behavior Unconsciousness Amnesia Adrenergic symptoms (from hypoglycemia-related adrenalin release): Weakness, sweating, tachycardia, palpitations, and hunger Seizures See Clinical Presentation for more detail. [emedicine.com]

• Seizure

  Case presentation: A 35-year-old male had history of night time seizures with hallucinations, delirium and spasms, lasting from 10 minutes to 1.5 hours for about 2 years. These seizures were always resolving spontaneously. [endocrine-abstracts.org]

  The following case report highlights the need for careful reassessment of all seizures that are atypical and refractory to medication. [ncbi.nlm.nih.gov]

  This case highlights the importance of considering hypoglycemia in the evaluation of night terrors and new-onset seizures. [pediatrics.aappublications.org]

• Confusion

  Forgetfulness and confusion You might forget things more easily and you, or the people that are close to you, may notice that you are confused. Behaving in a way that isn’t normal for you The people that are close to you might notice this. [cancerresearchuk.org]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Pancreatic tumor Blood glucose ≤40 mg/dL without other etiology Hypoglycemia symptoms without other etiology Confusion/altered consciousness Sweating/diaphoresis Headache Visual disturbance [arupconsult.com]

  Symptoms caused by low blood sugar (hypoglycemia) include faintness, weakness, headache, and confusion. Diagnosis includes blood and imaging tests. Treatment is surgery and sometimes chemotherapy. [msdmanuals.com]

  The clinical features of an insulinoma are fasting hypoglycemia with neuroglycopenic symptoms including confusion and unusual behavior, while hypertension is usually not associated with the disease. [ncbi.nlm.nih.gov]

• Tremor

  Sweating and tremors You might have a sudden onset of sweating and feel like you are shaking or having tremors. Palpitations You may feel that your heart is racing. This can make you feel dizzy, breathless and lightheaded. [cancerresearchuk.org]

  Adrenergic symptoms resulting from the catecholaminergic response include weakness, anxiety, nausea, hunger, sweating, tremor, tachycardia, and palpitations. [symptoma.com]

  The patients presented with symptoms of sweating, tremors, drowsiness, palpitations, loss of consciousness, abnormal behavior, seizures and weight gain. [ncbi.nlm.nih.gov]

  […] released as proinsulin With proinsulin release, equal amounts of C-peptide are also released Catecholamine excess is common Clinical Presentation Whipple triad Neurologic signs/symptoms of hypoglycemia (neuroglycopenia) – confusion, headache, sweating, tremor [arupconsult.com]

  Seizuring, tremoring, depressed, or poorly responsive patients should be hospitalized until blood sugar can be stabilized. [mspca.org]

• Dizziness

  He presented to our outpatient department with a two-week history of dizziness and morning cold sweats. A random serum glucose test revealed hypoglycaemia. [ncbi.nlm.nih.gov]

  This can make you feel dizzy, breathless and lightheaded. Whipple’s triad The Whipple’s triad is a collection of symptoms that help doctors diagnose an insulinoma. [cancerresearchuk.org]

  They produce the typical symptoms of low blood glucose levels: Excessive hunger Shaking Sweating Palpitations Ventricular tachycardia Nausea Dizziness The typical symptoms correspond to the so-called Whipple triad. [flexikon.doccheck.com]

  Approximately 3 hours later, the patient felt dizzy and lost consciousness when her plasma glucose level fell to 14 mg/dL. She also was found to have new hypokalemia of 2.6 mmol/L. [healio.com]

• Headache

  Headaches Headaches are a common symptom of many illnesses. [cancerresearchuk.org]

  Tabs Content Clinical Overview Diagnosis Indications for Testing Pancreatic tumor Blood glucose ≤40 mg/dL without other etiology Hypoglycemia symptoms without other etiology Confusion/altered consciousness Sweating/diaphoresis Headache Visual disturbance [arupconsult.com]

  Symptoms caused by low blood sugar (hypoglycemia) include faintness, weakness, headache, and confusion. Diagnosis includes blood and imaging tests. Treatment is surgery and sometimes chemotherapy. [msdmanuals.com]

  Neuroglycopenic symtoms oberserved in patients are headache, confusion, lethargy, diplopia, blurred vision, amnesia, seizures and in more severe cases unconsciousness. [symptoma.com]

Physiologically, the blood glucose level is maintained by a negative feedback mechanism. Decrease in blood glucose levels reduces insulin secretion. Inappropriately elevated levels of insulin in the presence of hypoglycemia and serum insulin to plasma glucose ratio > 0.3 (μU/mL)/(mg/dL) are diagnostic of insulinoma. Prolonged (ie, 48 or 72 h) supervised fast in hospitalized patients is the main test in diagnosing the condition. When symptoms of hypoglycemia appear, blood should be sampled and the biochemical diagnosis can be made, if the following parameters are found [7]:

• Blood glucose less than 40 mg/dL 
• C-peptide exceeding 2.5 ng/mL
• Absence of plasma sulfonylurea
• Increased serum insulin level of 10 µU/mL or more
• Increased proinsulin level of ≥25% or ≥22 pmol

After the biochemical diagnosis has been established, imaging studies are used to localize the tumor which is necessary to plan the surgical approach. Helical or multislice CT scan has 82-94% sensitivity, magnetic resonance imaging (MRI) 40-70%. Transabdominal ultrasonography, 111-In-pentetreotide imaging, and fluorine-18-L-dihydroxyphenylalanine positron emission tomography (18F-DOPA PET) are other noninvasive tests. Invasive modalities help to localize the tumor when non-invasive techniques are not sufficient. Endoscopic ultrasonography has up to 90% sensitivity [8], the accuracy of selective arteriography is 82%.

• Hypoglycemia

  Flash glucose monitoring (FGM) systems revealed glucose profiles with fasting hypoglycemia, which facilitated the clinical diagnosis of insulinoma even though she was unaware of her hypoglycemia. [ncbi.nlm.nih.gov]

  Further possible symptoms can be found in the article hypoglycemia. [flexikon.doccheck.com]

  However, postprandial hypoglycemia may accompany fasting hypoglycemia and may be the sole manifestation of hypoglycemia in some patients (21 and 6%, respectively). [cancertherapyadvisor.com]

• Hyperinsulinemia

  Insulin is antiglycogenolytic, and hyperinsulinemia permits retention of glycogen within the liver during the 72-hour fast. [healio.com]

  The fasting test was performed and the laboratory results showed endogenous hyperinsulinemia compatible with insulinoma. [ncbi.nlm.nih.gov]

• Fasting Hypoglycemia

  We report a rare case of an insulinoma diagnosed in an individual presenting exclusively with postprandial hypoglycemia without fasting hypoglycemia. [ncbi.nlm.nih.gov]

  […] patients during development of fasting hypoglycemia and in 8 normal volunteers studied over an identical interval. [diabetes.diabetesjournals.org]

• Glucose Decreased

  During a subsequent 8-h fast, glucose production and glucose utilization decreased in both groups, but more markedly in insulinoma patients. [diabetes.diabetesjournals.org]

Medical therapy is indicated in patients with malignant insulinomas and in those who are not surgical candidates. Diazoxide, octreotide and lanreotide (somatostatin analogues), verapamil [9] and phenytoin [10] and everolimus are used to treat insulinoma. Experiences with radiotherapy and chemotherapy are limited. Surgical excision of the insulinoma is the definitive treatment and currently the therapy of choice. Enucleation is the treatment option for all benign insulinomas, when technically feasible. For tumors that are anatomically unsuitable for enucleation or multiple tumors, a larger segmental resection of the pancreas, distal pancreatectomy or pancreaticoduodenectomy is performed.

The long-term survival rate of patients with benign insulinoma is normal. In patients with malignant insulinomas, survival is significantly worse. After surgical removal, the long-term risk of recurrence is high in patients with MEN-1 syndrome [4].

Insulinomas can occur sporadically or in association with multiple endocrine neoplasia (MEN)-1 syndrome. MEN-1 syndrome is an autosomal dominant disorder characterized by development of tumors in pituitary, parathyroid gland, pancreas, and the skin. It is associated with mutations in the MEN1 gene mapped to chromosome 11q13 [2] [3] and loss of heterozygosity. Sporadic insulinomas are typically less than 2 cm in diameter and solitary. Insulinomas associated with MEN-1 syndrome develop earlier, are frequently multiple and tend to recur.

The incidence is 3 to 10 cases per 1,000,000, but was reported to be higher in autopsy studies. The median age at diagnosis is approximately 47 years, with a mild female preponderance [4]. 5 to 10% are malignant and 16% of cases are associated with MEN-1 syndrome [5]. The median age at diagnosis of insulinomas in conjunction with MEN-1 syndrome is the mid 20s and malignant insulinomas are seen more frequently in this patient group. Insulinomas have been reported in all ethnic groups.

An insulinoma is a rare pancreatic endocrine tumor, deriving mainly from islet cells, that hypersecretes insulin. Rarely other hormones such as adrenocorticotropic hormone (ACTH), glucagon, gastrin, human chorionic gonadotropin, and somatostatin are produced by the tumor. Malignant tumors are usually larger in size and liver and regional lymph nodes are the most common sites of metastatic spread.

There are no guidelines for the prevention of insulinoma.

An insulinoma is a rare pancreatic endocrine tumor, deriving mainly from islet cells, that produces excessive amounts of insulin. 90-95% of insulinomas are benign. The incidence is 3 to 10 cases per 1,000,000 [1] and the majority of patients are between 30 and 60 years of age. The presentation is characterized by the Whipple triad in many patients which includes:

• Presence of symptoms and signs of hypoglycemia.
• Concomitant low blood sugar. 
• Reversibility of symptoms by glucose administration.

Surgical removal of the tumor is currently the treatment of choice and is curative in most cases. Medical therapy is indicated in patients with malignant insulinomas and in those who are not surgical candidates.

An insulinoma is a rare tumor in the pancreas that secretes insulin. In the majority of cases, the tumor is not cancerous (benign). Insulinomas are rare and tend to affect women more than men. They most frequently are diagnosed in people who are between ages 30 and 60.

The pancreas is an organ located behind the stomach which produces several important hormones, including insulin, glucagon, and somatostatin that control the level of sugar in the blood. When an insulinoma developed in the pancreas, it continues to secrete insulin, even when the blood sugar is too low, a condition called hypoglycemia. Symptoms include double vision, blurred vision, headache, lethargy, confusion, weakness, sweating, hunger, tremors, tremulousness, anxiety, rapid heart rate and in severe cases, seizures and coma.

To make the diagnosis, the doctor will perform a blood test to check blood sugar, insulin levels and several other values. To determine the location and size of the insulinoma, imaging studies will be made. The most common treatment for an insulinoma is surgical removal of the tumor and there are various types of surgery available to remove the insulinoma. If surgery is not possible, medical treatment is necessary.

1. Dadan J, Wojskowicz P, Wojskowicz A. Neuroendocrine tumors of the pancreas. Wiad Lek. 2008. 61(1-3):43-7.
2. Wermer P. Endocrine adenomatosis and peptic ulcer in a large kindred: inherited multiple tumors and mosaic pleiotropism in man. Am J Med. 1963;35:205–212.
3. Larsson C, Skogseid B, Oberg K, Nakamura Y, Nordenskjöld M. Multiple endocrine neoplasia type 1 gene maps to chromosome 11 and is lost in insulinoma. Nature. 1988;332:85–87.
4. Service FJ, McMahon MM, O’Brien PC, Ballard DJ. Functioning insulinoma: incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc 1991 66:711–719
5. Mukai K, Grotting JC, Greider MH, Rosai J. Retrospective study of 77 pancreatic endocrine tumors using the immunoperoxidase method. Am J Surg Pathol 1982;6:387-399
6. Vig S, Lewis M, Foster KJ, Stacey-Clear A. Lessons to be learned: a case study approach insulinoma presenting as a change in personality. J R Soc Promot Health 2001;121:56-61
7. Mathur A, Gorden P, Libutti SK. Insulinoma. Surg Clin North Am 2009;89:1105-21.
8. Schumacher B, Lubke HJ, Frieling T, Strohmeyer G, Starke AA 1996 Prospective study on the detection of insulinoma by endoscopic ultrasonography. Endoscopy 28:273–276
9. Hirshberg B, Cochran C, Skarulis MC, Libutti SK, Alexander HR, Wood BJ, Chang R, Kleiner DE, Gorden P. Malignant insulinoma: spectrum of unusual clinical features. Cancer. 2005;104(2):264.
10. Hofeldt FD, Dippe SE, Levin SR, Karam JH, Blum MR, Forsham PH. Effects of diphenylhydantoin upon glucose-induced insulin secretion in three patients with insulinoma. Diabetes. 1974;23(3):192.