<prompt> Gold standard test for insulinoma:72 hours fasting testPlasma insulin levelsC-peptide levelsLow glucose levels 30 mgdl  <response>: Ans. a. 72 hours fasting test 818; Blumgari 5e p935-937. Shackelford 7fepi206-210Gold standard test for the diagnosis of insulinoma is the 72-hour fasting test.Gold standard test for the diagnosis of insulinoma is the 72-hour fastinge test. An insulin-to-glucose ratio 0.4 is consistent with insulinomaInsulinoma Insulinoma is MC functioning tumor of the endocrine pancreas The average age at diagnosis is 45 years.Location of Insulinoma 97 in pancreas equal distribution in the head, body, and tail0 3 in duodenum, splenic hilum, or gastrocolic ligament0. Typically small, with an average size of 1.0 to 1.5 cm.Diagnostic hallmark is Whipples triad: Symptoms of hypoglycemia Low blood glucose levels 40-50 mgdL Relief of symptoms after the administration of glucose.Clinical Features:Diagnostic hallmark is Whipples triad0: Fasting-induced neuroglyopenic symptoms of hypoglycemia diaphoresis, shaking, mental confusion, obtundation, and seizures, low blood glucose levels 40 to 50 mgdL, and relief of symptoms after the administration of glucose.Sympathetic overactivity0 in response to hypoglycemia: Fatigue, weakness, fearfulness, hunger, tremor, diaphoresis, and tachycardia.CNS disturbance: Apathy, irritability, anxiety, confusion, excitement, loss of orientation, blurred vision, delirium, stupor, coma, andor seizures.Significant weight gain: Patients eat frequently to prevent hypoglycemia. its a painless condition.Diagnosis: Gold standard test for the diagnosis of insulinoma is the 72-hour fasting0 test. An insulin-to-glucose ratio 0.4 is consistent w ith insulinoma0. Provocative testing with tolbutamide, glucagon: or intravenous calcium is rarely required.CECT or MR1: Hyperattenuating as compared w ith surrounding pancreatic tissue because of rich vascular supplyLocalization: Angiography will detect approximately 70 of insulinomas 5 mm, showing a characteristic vascular blush0Portal venous sampling for insulin with or without arterial stimulation with calcium is the best pre-operative method of localization0. ELS with intra-operative palpation is best localization technique for Insulinoma0.Treatment: Diazoxide decreases beta cell release of insulin, used to prevent or attenuate symptoms of hypoglycemia prior to surgical interv ention once the diagnosis is made0. Insulinomas are well suited for laparoscopic resection or enucleations0.Insulinoma of head of pancreas Enucleation is TOCdegInsulinoma of body or tail of pancreas Distal pancreatectomy is TOCdeg 