{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:20:45Z","timestamp":1791991245706,"version":"4.4.0"},"reference-count":14,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,16]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>A man in his mid-30s presented to the emergency department following a motor vehicle accident with critically low blood glucose of 1.1 mmol\/L (3.9\u20135.6 mmol\/L) noted by emergency medical service and altered mental status. The patient reported progressive symptoms including tremor, sweating and difficulty concentrating, requiring continuous eating throughout the day, weight gain and hypoglycaemia unawareness.<\/jats:p>\n                  <jats:p>A 72-hour supervised fast confirmed endogenous hyperinsulinaemia, after 5\u2009hours, inappropriately elevated insulin of 26\u2009pmol\/L (diagnostic cut-off \u226518\u2009pmol\/L) and C-peptide &gt;0.33\u2009nmol\/L (expected &lt;0.2\u2009nmol\/L) with glucose 2.2\u2009mmol\/L (3.9\u20135.6\u2009mmol\/L). While CT and DOTATATE-positron emission tomography were negative, endoscopic ultrasound (EUS) and biopsy identified a 13\u2009mm pancreatic head well-differentiated neuroendocrine tumour.<\/jats:p>\n                  <jats:p>EUS-guided radiofrequency ablation (EUS-guided RFA) achieved immediate symptom resolution with normal postprocedure biochemical profile. In this case, EUS successfully identified the lesion when conventional imaging was negative and EUS-guided RFA resulted in successful treatment in this patient.<\/jats:p>","DOI":"10.1136\/bcr-2025-269256","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:45:17Z","timestamp":1769517917000},"page":"e269256","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic ultrasound-guided radiofrequency ablation of pancreatic insulinoma"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6787-5846","authenticated-orcid":false,"given":"Kidmealem","family":"Zekarias","sequence":"first","affiliation":[{"name":"Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Alutaibi","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Minnesota System, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmie","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Minnesota System, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guru","family":"Trikudanathan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"2026012704451228000_19.1.e269256.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)62083-7"},{"key":"2026012704451228000_19.1.e269256.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1410"},{"key":"2026012704451228000_19.1.e269256.3","doi-asserted-by":"crossref","first-page":"6135","DOI":"10.1097\/JS9.0000000000001395","article-title":"Updates in the management of postoperative pancreatic fistula","volume":"110","author":"Nebbia","year":"2024","journal-title":"Int J Surg"},{"key":"2026012704451228000_19.1.e269256.4","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000246856.03918.9a"},{"key":"2026012704451228000_19.1.e269256.5","doi-asserted-by":"crossref","first-page":"2834","DOI":"10.1016\/j.cgh.2023.02.022","article-title":"Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma","volume":"21","author":"Crin\u00f2","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026012704451228000_19.1.e269256.6","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3748\/wjg.v29.i1.157","article-title":"Endoscopic ultrasound guided radiofrequency ablation for pancreatic tumors: A critical review focusing on safety, efficacy and controversies","volume":"29","author":"Khoury","year":"2023","journal-title":"World J Gastroenterol"},{"key":"2026012704451228000_19.1.e269256.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2010.08.030"},{"key":"2026012704451228000_19.1.e269256.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0206099","article-title":"Diagnostic value of endoscopic ultrasound for insulinoma localization: A systematic review and meta-analysis","volume":"13","author":"Wang","year":"2018","journal-title":"PLoS ONE"},{"key":"2026012704451228000_19.1.e269256.9","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1159\/000514809","article-title":"Dual-Tracer (68Ga-DOTATOC and 18F-FDG-)-PET\/CT Scan and G1-G2 Nonfunctioning Pancreatic Neuroendocrine Tumors: A Single-Center Retrospective Evaluation of 124 Nonmetastatic Resected Cases","volume":"112","author":"Paiella","year":"2022","journal-title":"Neuroendocrinology"},{"key":"2026012704451228000_19.1.e269256.10","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1210\/jc.2016-3445","article-title":"Localization of Insulinoma Using 68Ga-DOTATATE PET\/CT Scan","volume":"102","author":"Nockel","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"2026012704451228000_19.1.e269256.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2012.04.477"},{"key":"2026012704451228000_19.1.e269256.12","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1111\/den.14224","article-title":"Management of non-functional pancreatic neuroendocrine tumors by endoscopic ultrasound-guided radiofrequency ablation: Retrospective study in two tertiary centers","volume":"34","author":"Marx","year":"2022","journal-title":"Dig Endosc"},{"key":"2026012704451228000_19.1.e269256.13","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1080\/17474124.2024.2321938","article-title":"Endoscopic ultrasound-guided radiofrequency ablation of pancreatic insulinoma: a state of the art review","volume":"18","author":"Dhar","year":"2024","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2026012704451228000_19.1.e269256.14","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.pan.2023.05.004","article-title":"Safety and efficacy of endoscopic ultrasound-guided radiofrequency ablation for pancreatic insulinoma: A single-center experience","volume":"23","author":"Borrelli de Andreis","year":"2023","journal-title":"Pancreatology"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269256","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:45:18Z","timestamp":1769517918000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269256"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,27]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-269256"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269256","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}