Magnetic resonance imaging of her stomach demonstrated a mmprimary tumor causing development in the human body of pancreas with multiple lymph nodes near portal hilus around celiac trunk andmultiplemetastatic lesions in both lobes of the liver with the greatest one 5 cm in length. Histological examination of the liver lesions was described as neuroendocrine tumour metastasis with ubiquitin-conjugating constructive immunohistochemical staining for synaptophysin and chromogranin and a Ki 67 catalog below a day later. Indium 111 pentetreotide scan demonstrated intense uptake of the radiotracer in primary pancreatic tumour, in regional lymph nodes and multifocal liver lesions. She was considered as inoperable because of the attack of the large vessels next to the main tumor and widespread distribution of liver metastases. The patient was discussed at our multidisciplinary tumor board and she was deemed inoperable and medical therapy was advised. Subcutaneous Short-acting somatostatin analogue, octreotide, was used, but no clinical improvement was observed in spite of measure rise around 200??g three RNAP times daily. Radioembolization of the liver metastatic lesions was performed concomitantly by adding 50 mCi Yttrium 90 labeled resin microspheres via hepatic artery. After a month of in patient treatment since radioembolization with ongoing subcutaneous Short-acting octreotide therapy, the patient still required continuous and regular intravenous dextrose infusion and could not be discharged.. Even though her insulin and C peptide levels were lower throughout hypoglycemia, they were still above the reference limits.. PFT alpha The unhappy clinical state of this malignant inoperable insulinoma patient led us to look for the limited medical literature on this topic again. A determination was produced in favour of withdrawing octreotide and giving her verbal everolimus treatment with radiotherapy to the primary tumour, which was thought to be a substantial source of endogenous insulin secretion. Common everolimus treatment at a dose of 10mg once-daily and concomitant 15 fractioned amounts and 45 Grey radiotherapy received. The individual showed immediate favourable reaction to the new treatment that has been clearly documented with blood glucose monitoring. Her continuous requirement for dextrose infusion started to decrease on the fifth day of everolimus and dextrose infusion was completely taken on the seventh day of everolimus. She became relatively well in situation and can find a way to remain without dextrose infusion all day. However, release was again difficult as a result of living threatening hypoglycemic episodes that happened suddenly. Throughout one of those episodes, her blood glucose was observed to be 32mg/dL with C peptide levels 13 and relatively large simultaneous insulin. 4??IU/mL and 0. 86 pmol/L, respectively. At the end of her second month of hospitalisation, while she was doing pretty well on everolimus 10mg/day, anMRI of stomach was re-performed.