Snap Shot A referal patient presents with intermitten neurologic abnormalities associated with hypoglycemia. The patient has an attack while in the office. You draw labs at the time. The attack is relieved by giving glucose. A week later the labs come back with a low serum glucose, a high insulin level, and a high C-peptide. Introduction Most common islet cell tumor Due to hyperplasia of insulin producing B-cells 90% benign Whipple Triad hypoglycemia CNS symptoms from hypoglycemia administration of glucose resolves symptoms Presentation Symptoms of hypoglycemia Evaluation Labs will show low blood glucose high serum insulin high C-peptide Insulin glucose ratio > 0.4 Increase in C-peptide Urine/serum sulfonylureas (factitious disorder) Treatment Enucleate