Glycemic Control in Patients with Insulinoma Treated with Everolimus

To the Editor: Management of refractory hypoglycemia due to malignant insulinoma is challenging. Currently available treatments include dietary modification, diazoxide, and, in patients with resistant disease, the use of intravenous dextrose infusion or enteral feedings. Patients with advanced, unresectable insulinomas often have prolonged hospitalizations and may have fatal complications from this disease. The mammalian target of rapamycin (mTOR) is a serine–threonine protein kinase that has been implicated in the cellular response to nutrients and growth factor signaling; mTOR functions downstream of phosphatidylinositol 3-kinase and AKT (also known as protein kinase B) and is abnormally activated in a number of cancers. . . .