Case Report: A case of occult insulinoma localized by [

Background: Insulinomas, the most common functional pancreatic neuroendocrine tumors, cause hypoglycemia due to excessive insulin production, leading to severe clinical symptoms like coma or death. Resection surgery is the major curative treatment, but preoperative localization is challenging due to their small size. Traditional imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI) often fail to detect tumors, while more invasive procedures like endoscopic ultrasound tissue acquisition (EUS-TA) and the selective arterial calcium stimulation test (SACST), though informative, depend heavily on operator skill and may not always provide conclusive results. There is an urgent need for non-invasive, sensitive localization methods for insulinomas. Glucagon-like peptide 1 receptor (GLP-1R) targeted PET imaging has emerged as a promising tool. We present a clinical case where [ Case description: A 67-year-old female developed hyperinsulinemic hypoglycemia but could not undergo surgery as conventional imaging methods failed to localize the insulinoma. She was managed with diazoxide for six years, but her symptoms worsened. At 73, she was referred to our hospital. CT, MRI, endoscopic ultrasound, and SACST failed to detect the tumor in any artery. However, Discussion: This case demonstrates the utility of Conclusion: The