A 13-year-old previously healthy boy presents with a 2-year history of what is described as 4 episodes of unusual behavior. During these episodes he becomes acutely upset, with complaints of palpitations, tremors, and hunger that resolve several minutes after eating. He describes additional episodes not associated with hunger during which he feels dizzy and presyncopal for a minute, occurring approximately once every 6 months. These occur within minutes of eating and/or drinking, and none have occurred after an overnight fast. There is no flushing or pallor noted by observers during these events. He does not have access to insulin or sulfonylureas.
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