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Summary  Despite improvements in localisation techniques and surgical advances, some patients with insulinoma will not be cured by surgery or may not be suitable for surgery. Medical management with diazoxide is an option for such cases. This case report details 27 years of successful management of insulinoma using diazoxide. It has been effective and safe, with only minor adverse effects.    Learning points:    Long term diazoxide use can be a safe, effective option for insulinoma when it cannot be localised or removed surgically.    Common adverse effects include peripheral oedema, hyperuricaemia, and hirsutism.     68 Ga-NOTA-exendin-4 PET/CT scan should be considered for insulinoma localisation when other modalities have been unhelpful.

Successful medical management of insulinoma with diazoxide for 27 years