Importance of Selective Arterial Calcium Stimulation with Hepatic Venous Sampling in Management of a Patient with Multifocal Insulinoma

Insulinoma is a rare neuroendocrine tumour arising from beta cells of pancreatic islets Langerhans. We report case insulinoma presented with vague manifestations, which were undiagnosed for 2 years. The diagnostic evaluation revealed endogenous hyperinsulinism and imaging showed head lesion she underwent the surgery. Due to persisting symptoms, Calcium arterial stimulation hepatic venous sampling was later performed it localized an occult that not visible during radiological or surgical assessment. Diagnosis insulinomas remains clinical challenge. Selective calcium reliable pre-operative procedure positive diagnosis insulinoma.