title: Intermittent everolimus administration for malignant insulinoma.
abstract: Insulinoma is a rare form of insulin-secreting pancreatic islet cell neuroendocrine (NE) tumor. The medical treatment of the malignant NE disease of the pancreas deeply changed in the last years, thanks to the introduction of new target molecules, as everolimus. Even if the exact mechanism is not actually known, one of the side effects of everolimus, hyperglycemia, has been demonstrated to be useful to contrast the typical hypoglycemia of the insulinoma. We report the case of a patient with a metastatic malignant insulinoma treated with intermittent everolimus, obtaining an important improvement in the quality of life; this suggests the necessity of preclinical studies to analyze the cellular pathways involved in insulin-independent gluconeogenesis.
  
  
  CONCLUSIONS
  Effect of somatostatin analogs is long-lasting in the control of functioning NE tumors.Persistent everolimus control of hypoglycemia despite serum insulin levels and disease progression.OPEN ISSUE: are disease progression and the increase in serum markers the only valid criteria to reject a treatment?
authors.affiliation: Dipartimento di Oncologia, Oncologia Medica, Università di Torino, Azienda Ospedaliero Universitaria San Luigi Gonzaga , Regione Gonzole 1010043, Orbassano , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Baratelli
authors.affiliation: Dipartimento di Oncologia, Oncologia Medica, Università di Torino, Azienda Ospedaliero Universitaria San Luigi Gonzaga , Regione Gonzole 1010043, Orbassano , Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Brizzi
authors.affiliation: Dipartimento di Oncologia, Oncologia Medica, Università di Torino, Azienda Ospedaliero Universitaria San Luigi Gonzaga , Regione Gonzole 1010043, Orbassano , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Tampellini
authors.affiliation: Dipartimento di Oncologia, Oncologia Medica, Università di Torino, Azienda Ospedaliero Universitaria San Luigi Gonzaga , Regione Gonzole 1010043, Orbassano , Italy.
authors.forename: Giorgio Vittorio
authors.initials: GV
authors.lastname: Scagliotti
authors.affiliation: SCDU Radiologia, Università di Torino, Azienda Ospedaliero Universitaria San Luigi Gonzaga , Regione Gonzole 1010043, Orbassano , Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Priola
authors.affiliation: Dipartimento di Scienze Cliniche e Biologiche, Medicina Interna, Università di Torino, Azienda Ospedaliero Universitaria San Luigi Gonzaga , Regione Gonzole 1010043, Orbassano , Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Terzolo
authors.affiliation: Dipartimento di Scienze Cliniche e Biologiche, Medicina Interna, Università di Torino, Azienda Ospedaliero Universitaria San Luigi Gonzaga , Regione Gonzole 1010043, Orbassano , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Pia
authors.affiliation: Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica Università di Brescia, Oncologia Medica, Azienda Ospedaliera Spedali Civili , Brescia , Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti