<prompt> Whipples triad in insulinoma include all EXCEPTACTH is treatment of choiceSymptoms relieved by glucoseHypoglycemia below 45 mgAn attack of hypoglycemic in the fasting stage  <response>: A ACTH is treatment of choice Features of Insulinoma: Insulinomas are solitary benign rare neuroendocrine tumours with an incidence estimated at 1 to 4 new cases per million persons per year. Insulinoma is one of the most common types of tumour arising from the islets of Langerhans cells pancreatic endocrine tumours. Estimates of malignancy metastases range from 5 to 30. Over 99 of insulinomas originate in the pancreas, with rare cases from ectopic pancreatic tissue. About 5 of cases are associated with tumours of the parathyroid glands and the pituitary Multiple endocrine neoplasia type 1 and are more likely to be multiple and malignant. Most insulinomas are small, less than 2 cm. Signs Symptoms Patients with insulinomas usualiy develop neuroglycopenic symptoms. These include recurrent headache, lethargy, diplopia, and blurred vision, particularly with exercise or fasting. Severe hypoglycemia may result in seizures, coma, and permanent neurological damage. Symptoms resulting from the catecholaminergic response to hypoglycemia i.e. tremulousness, palpitations, tachycardia, sweating, hunger, anxiety, nausea are not as common. Sudden weight gain the patient can become massively obese is sometimes seen. 