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I consider 70 with clinical signs of insulinoma to be insulinoma until
proven otherwise.  You say that you have seen some response to a fairly
low dose of pediapred, and that seems fairly confirmatory to me.
Obviously the pancreas should be inspected during surgery, and if nodules
are found they should be removed, but often the insulinomas are too small
to be seen and in that event a partial pancreatectomy would be indicated,
IMO.  Another option would be to run an insulin level, with a blood sugar
at the same time, to confirm the diagnosis before surgery.
 
Dr. Ruth
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Puppies kiss better than most people.
[Posted in FML issue 4712]