Type B Insulin Resistance Masquerading as Ovarian Hyperthecosis.

Abstract

Context:

Hyperinsulinemia can lead to pathologic ovarian growth and androgen production.

Case Description:

A 29-year-old woman developed an autoantibody to the insulin receptor (type B insulin resistance), causing extreme insulin resistance and hyperinsulinemia. Testosterone levels were elevated to the adult male range. Treatment with gonadotropin-releasing hormone (GnRH) analog led to normalization of testosterone, despite persistent extreme insulin resistance.

Conclusions:

This case demonstrates that gonadotropins are necessary for insulin to cause pathologic ovarian androgen production. Suppression of gonadotropins with GnRH analogs may be a useful therapeutic option in patients with severe hyperandrogenism or ovarian enlargement because of hyperinsulinemia.

• Authors: Rebecca J Brown, Jalaja Joseph, Elaine Cochran, Cornelia Gewert, Robert Semple, Phillip Gorden
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 102 Issue 6 Pg. 1789-1791 (06 01 2017) ISSN: 1945-7197 [Electronic] United States
• PMID: 27911591 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents, Hormonal
• Autoantibodies
• Immunosuppressive Agents
• Gonadotropin-Releasing Hormone
• Testosterone
• Rituximab
• Dexamethasone
• Cyclophosphamide
• Receptor, Insulin
• Leuprolide

Topics

• Adult
• Antineoplastic Agents, Hormonal (therapeutic use)
• Autoantibodies (immunology)
• Cyclophosphamide (therapeutic use)
• Dexamethasone (therapeutic use)
• Diagnosis, Differential
• Female
• Gonadotropin-Releasing Hormone (analogs & derivatives)
• Humans
• Hyperandrogenism (blood, diagnosis, drug therapy)
• Hyperinsulinism (blood, diagnosis)
• Immunosuppressive Agents (therapeutic use)
• Insulin Resistance (immunology)
• Leuprolide (therapeutic use)
• Ovarian Diseases (blood, diagnosis, drug therapy)
• Receptor, Insulin (immunology)
• Rituximab (therapeutic use)
• Testosterone (blood)