While insulin represents a valid option in acromegalic and CS patients, in PPGL pioglitazone could be evaluated considering its antiproliferative effects reported in pheochromocytoma cells, whereas insulin should represent a last-step therapy in case of poor glycemic control or intolerance/contraindication to pioglitazone [147, 152]. This evidence concerns the gene INS and hereditary pheochromocytoma-paraganglioma.