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Background: Insulin-secreting tumors are the most common hormone-producing neoplasm of the gastrointestinal tract. Only 10 percent of overall cases of insulinoma have malignant variants, which have a poor prognosis. Cases Report: The present study reports an unusual case of pancreatic neuroendocrine tumor associated with hypoglycemia and liver metastasis as the initial presentation followed a rapidly progressive clinical course. A few cases of malignant insulinoma were reported with favorable responses in the literature. This research presents a patient with resistant malignant insulinoma who could not undergo an operation and received treatment with somatostatin analogs (S.S.A.), Peptide Receptor Radionuclide Therapy (PRRT), and other supportive care that was inappropriate. Conclusion: Early diagnosis and extensive treatment are auspicious for improving the prognosis of malignant insulinoma, and proper treatment with medications would increase the quality of life of patients. Nevertheless, unfortunately, late patient referrals, socioeconomic conditions, and being infected with Covid-19 disease resulted in death. [ABSTRACT FROM AUTHOR]

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