The increase of serum immunoreactive insulin levels in response to secretin is significantly lower than in normal persons.20 A combination of gadolinium MRI, triple-phase CT, octreotide scanning, selective intra-arterial calcium stimulation, and particularly endoscopic and intraoperative ultrasound may actually detect almost all lesions.21 The initial treatment of childhood insulinoma is dietary and focused on preventing hypoglycemia. This evidence concerns the gene INS and pancreatic insulinoma.