Fortunately, no fatigue. Hypoglycemia worsened but that could also be tumor growth in the pancreas. They have not discussed biopsy due to the indeterminate nature of the lesions on imaging as well as the invasiveness of a liver biopsy. The test I am having in April is a Calcium Stimulation test. The calcium gluconate will stimulate insulinomas to produce insulin. They will perform the stimulation across both the liver and the pancreas. If there is an increase in insulin levels, the area stimulated is positive for a tumor. The pancreatic tumors are not clearly visible on imaging so this test is how they know I have additional tumors in the pancreas. They will do the same to determine if the lesions in the liver are functional insulinomas. Hope this make sense. . .
They have done the test twice before and so far the liver has remained negative for tumors. It has been a couple of years since the last test. There has been an increase in the frequency and severity of hypoglycemia episodes as well as some changes in the imaging - thus the reason for the repeat test coming up.