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.
Trial registration:
ClinicalTrials.gov NCT00001987.
Publication types
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Case Reports
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Research Support, N.I.H., Intramural
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Research Support, Non-U.S. Gov't
MeSH terms
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Adult
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Antineoplastic Agents, Hormonal / therapeutic use
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Autoantibodies / immunology
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Cyclophosphamide / therapeutic use
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Dexamethasone / therapeutic use
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Diagnosis, Differential
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Female
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Gonadotropin-Releasing Hormone / analogs & derivatives
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Humans
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Hyperandrogenism / blood
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Hyperandrogenism / diagnosis*
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Hyperandrogenism / drug therapy
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Hyperinsulinism / blood
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Hyperinsulinism / diagnosis*
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Immunosuppressive Agents / therapeutic use
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Insulin Resistance / immunology*
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Leuprolide / therapeutic use
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Ovarian Diseases / blood
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Ovarian Diseases / diagnosis*
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Ovarian Diseases / drug therapy
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Receptor, Insulin / immunology*
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Rituximab / therapeutic use
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Testosterone / blood
Substances
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Antineoplastic Agents, Hormonal
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Autoantibodies
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Immunosuppressive Agents
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Gonadotropin-Releasing Hormone
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Testosterone
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Rituximab
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Dexamethasone
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Cyclophosphamide
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Receptor, Insulin
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Leuprolide
Associated data
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ClinicalTrials.gov/NCT00001987