A 45-year-old man has recurrent fasting hypoglycaemia with inappropriately high plasma insulin and negative abdominal CT. Which statement about his most likely diagnosis is correct?

• A Most lesions are multiple and located in the pancreatic tail
• B Endoscopic ultrasound is the most sensitive preoperative localisation modality ✓
• C Approximately half of cases occur as part of MEN2 syndrome
• D Enucleation is contraindicated because of high recurrence rates

Explanation

Insulinomas follow the rule of tens: mostly under 2 cm, single in about 90 percent, benign in about 90 percent, and intrapancreatic. Endoscopic ultrasound detects roughly 90 percent of lesions and outperforms conventional cross-sectional imaging for these small tumours, guiding enucleation or limited resection. Association with MEN1 occurs in only about 10 percent, and MEN2 involves medullary thyroid and phaeochromocytoma instead. Enucleation of small superficial lesions away from the main duct is the preferred operation with low recurrence.

Reference: Greenfield's Surgery: Scientific Principles and Practice, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.