INS and Hepatic failure: Aside from insulinoma, common differential diagnoses of hypoglycemia include spurious laboratory results, hypoadrenocorticism, hepatic insufficiency, portosystemic shunts, sepsis, and nonpancreatic neoplasia producing incompletely processed insulin-like growth factors (e.g., hepatocellular carcinoma, leiomyosarcoma, and metastatic mammary carcinoma and lymphoma) [6,85,86].