A 72-year-old woman with a history of diabetes mellitus presented with severe episodes of hypoglycemia, associated with diaphoresis and somnolence, for 1 year. Workup revealed high insulin and c-peptide. Given the clinical suspicion of an insulinoma, an MRI was performed, which demonstrated abnormal enhancement in the pancreatic head. An octreotide scan with combined single-photon emission computed tomography–computed tomography was performed and fused to the MR, which identified radiotracer uptake at the site of the MR enhancement, enabling precise localization of a pancreatic somatostatin receptor–avid tumor. The patient underwent tumor enucleation with pancreatojejunostomy, and pathologic tests confirmed an insulinoma.