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We present the case of a patient with a history of symptomatic hypoglycaemic episodes and a negative 72-hour fasting test with histological confirmation of insulinoma. A literature review of hyperinsulinaemic hypoglycaemia with a negative fasting test was performed., Learning Points: The 72-hour fasting test is the gold standard for insulinoma diagnosis.Few cases of insulinoma with a negative fasting test have been reported.New strategies for insulinoma diagnosis are being investigated., Competing Interests: Conflicts of Interests: The authors declare there are no competing interests., (© EFIM 2022.)