{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:03:02Z","timestamp":1790337782445,"version":"4.1.0"},"reference-count":9,"publisher":"Walter de Gruyter GmbH","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jbcpp-2026-0193_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Insulinoma is a rare pancreatic neuroendocrine tumor causing endogenous hyperinsulinemic hypoglycemia. Its heterogeneous clinical presentation often delays diagnosis. Dietary patterns, particularly ketogenic or high-carbohydrate regimens, may influence glucose homeostasis and modify the clinical manifestations of insulinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jbcpp-2026-0193_abs_002\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 70-year-old woman was admitted with recurrent documented hypoglycemia. She reported a 10-year history of seizure-like episodes and intermittent neurological symptoms that began after starting a ketogenic diet. Symptoms later became less frequent during a high-calorie, carbohydrate-rich diet but recurred after adopting a Mediterranean diet. Biochemical evaluation confirmed endogenous hyperinsulinemic hypoglycemia. A supervised fasting test documented symptomatic hypoglycemia with plasma glucose of 17\u202fmg\/dL, fulfilling Whipple\u2019s triad. Magnetic resonance imaging revealed a 4\u202fcm pancreatic tail lesion, and \u02c668\u202fGa-DOTATATE PET\/CT showed intense uptake consistent with a somatostatin receptor-positive neuroendocrine tumor. As the patient declined surgery, diazoxide and dietary modifications were started, improving symptoms and glycemic control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jbcpp-2026-0193_abs_003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case suggests that dietary habits may influence the clinical presentation of insulinoma. Marked carbohydrate restriction may unmask hypoglycemia, whereas high-carbohydrate intake may attenuate symptoms and contribute to delayed diagnosis. Careful assessment of dietary habits should be part of the evaluation of patients with recurrent unexplained hypoglycemia suggestive of insulinoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jbcpp-2026-0193","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:56:15Z","timestamp":1789556175000},"page":"447-452","source":"Crossref","is-referenced-by-count":0,"title":["To eat, or not to eat\u2026 dietary patterns and the clinical recognition of insulinoma: a case report"],"prefix":"10.1515","volume":"37","author":[{"given":"Lorenzo","family":"Timpani","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Arcopinto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"},{"name":"Department of Translational Medical Sciences , Federico II University , Naples , Italy"},{"name":"Interdepartmental Center for Gender Medicine Research \u201cGENESIS\u201d, Federico II University , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Cudemo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"De Fortuna","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariarosaria","family":"De Luca","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"De Vito","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6968-4947","authenticated-orcid":false,"given":"Anna","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Lucci","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Salzano","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"},{"name":"Department of Translational Medical Sciences , Federico II University , Naples , Italy"},{"name":"Interdepartmental Center for Gender Medicine Research \u201cGENESIS\u201d, Federico II University , Naples , Italy"},{"name":"Cardiac Unit, AORN a Cardarelli , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Alsergani","sequence":"additional","affiliation":[{"name":"King Saud University , Riyadh , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Napoli","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences , Precision Internal Medicine Unit\u00b8 Federico II University of Naples Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Guardasole","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cittadini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Complexity , Internal Medicine and Cardio-Metabolic Rehabilitation Unit, AOU Federico II , Naples , Italy"},{"name":"Department of Translational Medical Sciences , Federico II University , Naples , Italy"},{"name":"Interdepartmental Center for Gender Medicine Research \u201cGENESIS\u201d, Federico II University , Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"2026092511294105511_j_jbcpp-2026-0193_ref_001","doi-asserted-by":"crossref","unstructured":"Service, FJ, McMahon, MM, O\u2019Brien, PC, Ballard, DJ. Functioning insulinoma\u00a0\u2013\u00a0incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc 1991;66:711\u201319. https:\/\/doi.org\/10.1016\/S0025-6196(12)62083-7.","DOI":"10.1016\/S0025-6196(12)62083-7"},{"key":"2026092511294105511_j_jbcpp-2026-0193_ref_002","doi-asserted-by":"crossref","unstructured":"Hofland, J, Refardt, JC, Feelders, RA, Christ, E, de Herder, WW. Approach to the patient: insulinoma. J\u00a0Clin Endocrinol Metab 2024;109:1109\u201318. https:\/\/doi.org\/10.1210\/clinem\/dgad641.","DOI":"10.1210\/clinem\/dgad641"},{"key":"2026092511294105511_j_jbcpp-2026-0193_ref_003","doi-asserted-by":"crossref","unstructured":"Howarth, S, Ho, TW, Wimbury, J, Casey, R. Managing hypoglycaemia in patients with insulinoma: a tertiary centre experience and review of the literature. 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Ketogenic weight loss diet rapidly unmasks an insulinoma. Case Rep Endocrinol 2019;2019:9674245. https:\/\/doi.org\/10.1155\/2019\/9674245.","DOI":"10.1155\/2019\/9674245"},{"key":"2026092511294105511_j_jbcpp-2026-0193_ref_009","doi-asserted-by":"crossref","unstructured":"Sada, A, Habermann, EB, Szabo Yamashita, T, Thompson, GB, Lyden, ML, Foster, TR, et al.. Comparison between sporadic and multiple endocrine neoplasia type 1-associated insulinoma. 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