Abstract
Insulinomas are rare neuroendocrine neoplasms and causes of hypoglycemia. They present with neuroglycopenic symptoms, including confusion and seizures. Suspected diagnosis must be confirmed through bloodwork and imaging. The majority of insulinomas are benign and cured surgically; less than 10% of insulinomas are malignant. Malignant insulinomas present a unique and rare challenge in managing persistent hypoglycemia and tumor burden. We present a case of a young woman who presented with Whipple triad and high-grade masses in her pancreas, liver, and distant lymph node metastases on imaging. Insulinoma was diagnosed. Hypoglycemia was managed with continuous dextrose infusion, diazoxide, and lanreotide. She was discharged on medical management and a continuous glucose monitor. Her metastatic disease is being treated with a capecitabine and temozolomide (CAPTEM) regimen showing 30% reduction in tumor burden. In conjunction with the National Institutes of Health, she is undergoing evaluation with numerous neuroendocrine tumor surgeons for cytoreductive surgery.