Alpelisib in Intractable Non–Islet-Cell Tumor Hypoglycemia

This correspondence reports the successful use of alpelisib, a PI3 kinase inhibitor, to treat intractable hypoglycemia in a 57 year old man with a recurrent solitary fibrous tumor secreting prohormone insulin like growth factor II (proIGF-II). Despite failed surgical and antineoplastic interventions, alpelisib (300 mg/day) rapidly restored normoglycemia, eliminating the need for continuous glucose infusion. In vitro studies demonstrated that proIGF-II activated insulin–IGF-I signaling in human skeletal muscle cells, increasing glucose uptake via AKT phosphorylation effects reversed by alpelisib. This case highlights alpelisib’s potential as a targeted therapy for NICTH, addressing a critical unmet need in managing tumor induced hypoglycemia.

This correspondence reports the successful use of alpelisib, a PI3 kinase inhibitor, to treat intractable hypoglycemia in a 57 year old man with a recurrent solitary fibrous tumor secreting prohormone insulin like growth factor II (proIGF-II). Despite failed surgical and antineoplastic interventions, alpelisib (300 mg/day) rapidly restored normoglycemia, eliminating the need for continuous glucose infusion. In vitro studies demonstrated that proIGF-II activated insulin–IGF-I signaling in human skeletal muscle cells, increasing glucose uptake via AKT phosphorylation effects reversed by alpelisib. This case highlights alpelisib’s potential as a targeted therapy for NICTH, addressing a critical unmet need in managing tumor induced hypoglycemia.