A 40-year-old woman has recurrent morning sweating, tremulousness, and confusion relieved by eating. Supervised 72-hour fast reproduces the symptoms with glucose 38 mg/dL, inappropriately high insulin, elevated C-peptide, and negative sulfonylurea screen, confirming insulinoma. After biochemical confirmation, the most appropriate next step is:

• A Streptozocin-based chemotherapy as first-line management
• B Empirical subtotal pancreatectomy without localization
• C Lifelong diazoxide therapy as definitive treatment
• D Endoscopic ultrasonography or CT for localization before surgical enucleation ✓

Explanation

Once the biochemical diagnosis of insulinoma is secure, cross-sectional imaging with CT or MRI and endoscopic ultrasound localize the tumour, allowing targeted enucleation or distal pancreatectomy. Over 90 percent of insulinomas are solitary and benign, so blind subtotal pancreatectomy is never justified. Diazoxide is a temporizing measure when localization fails or surgery is unsuitable, and streptozocin is reserved for unresectable or metastatic disease.

Reference: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.