A 7-year old boy was brought by his mother to the clinic for frequent severe headaches, described as sharp pain over his vertex for the past two months. During these episodes, he would appear pale and sweaty, with nausea and blurred vision. On examination, the patient was alert and appropriate, with normal vital signs. Systemic and neurological examinations were unremarkable. A magnetic resonance imaging (MRI) brain scan was normal. Post-MRI, after prolonged fasting for sedation, he complained of hunger and severe headache, with pallor and sweatiness. A capillary glucose test demonstrated hypoglycaemia of 1.8 mmol/L.On further questioning, the mother reported that the child had an afebrile seizure 2 months prior. She also reported tantrums, sweating and headaches when the patient was hungry. This history suggested underlying recurrent hypoglycaemia, with