INSR and hyperinsulinism: However, this comorbidity is an important factor in carcinogenesis (Shafqet et al., 2017) in that hyperinsulinemia stimulates greater expression of type 1 insulin-like growth factor (IGF-1) and insulin receptors via PI3K/Akt/mTOR signaling, thus triggering proliferation, angiogenesis, metastasis, and inhibition of apoptosis (Wojciechowskaet al., 2016; Labibet al., 2019; Clements et al., 2020).