Additionally, in malignant neoplasms, hyperinsulinemia may potentiate the proliferative effect of IGF-2, which is overexpressed in 90% of adrenocortical carcinomas [83,84], through the binding of insulin receptor A (IR-A), IGF-1 receptor (IGF-1R) and hybrid receptor IR-A/IGF-1R. Here, IGF1R is linked to hyperinsulinism.