Objective:

To report a case of insulinoma diagnosed in the first trimester of pregnancy and to highlight the diagnostic challenges and management complexities, emphasizing its rarity and implications for clinical practice.

Key Findings:

• Insulinoma during pregnancy is rare, with fewer than 30 cases reported, underscoring the need for heightened awareness among clinicians.
• Diagnosis is often delayed due to overlapping symptoms with normal pregnancy, which can lead to significant maternal and fetal risks.
• Biochemical evaluation indicated endogenous hyperinsulinaemia, confirming the diagnosis.
• Magnetic resonance imaging identified a pancreatic lesion consistent with insulinoma, guiding treatment decisions.
• Medical therapy with octreotide was initiated, achieving partial glycaemic control, but further management was complicated by fetal growth restriction.

Interpretation:

The case illustrates the diagnostic challenges of insulinoma in pregnancy and the importance of a multidisciplinary approach to management.

Limitations:

• Limited sensitivity of ultrasound for insulinoma detection, which may lead to misdiagnosis.
• Concerns regarding teratogenicity and fetal growth restriction with medical therapies, necessitating careful risk-benefit analysis.
• Evidence for minimally invasive approaches like endoscopic radiofrequency ablation is limited, highlighting the need for further research.

Conclusion:

The case emphasizes the need for individualized management strategies, highlights the complexities involved in treating insulinoma during pregnancy, and suggests areas for future research to improve outcomes.