• Aqeel Shakir Mahmood, Ahmed Dheyaa Al-Obaidi, Mazin Judy Ibrahim, Mustafa Najah Al-Obaidi, Ahmed A Shakir, Reema Yousif Bakose, Naseem Wajdi, and Hashim Talib Hashim.
• Baghdad University, College of Medicine Baghdad, Baghdad, Iraq.
• Medicine (Baltimore). 2023 Apr 7; 102 (14): e33456e33456.

RationalePancreatic insulinomas are the most frequent pancreatic endocrine neoplasms. They are insulin-secreting pancreatic tumors that induce extreme, recurrent, and near-fatal hypoglycemia. Insulinomas affect 1 to 4 individuals in a million of the general population and account for about 1% to 2% of all pancreatic tumors.Patient ConcernsRecurrent episodes of sweating, tremor, weakness, confusion, palpitation, blurred vision, and fainting for 2 months and was misdiagnosed as having atrial fibrillation.DiagnosisHe was misdiagnosed as having atrial fibrillation to highlight the importance of atrial fibrillation as unusual mimicker of insulinoma and to encourage clinicians about the importance of early and appropriate management in such cases.InterventionsEndoscopic ultrasound for the pancreatic parenchyma was done, and it showed a hypoechoic homogenous mass located at the pancreatic head measuring 12 mm × 15 mm with no local vascular involvement, blue in elastography, hypervascular with Doppler study, and a normal pancreatic duct diameter.OutcomesHis condition was stable, and he was discharged home 2 days later.ConclusionThe diagnosis of insulinoma is usually difficult and late due to the extremely low incidence of the disease and the similarity of its clinical presentation to numerous other conditions, the most reported is epilepsy.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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