Session: SAT 758-785-Diabetes Case Reports: Type 1, Type 2, MODY & Complications
Poster Board SAT-776
Case: A 32 year old African American woman presented with secondary amenorrhea, virilization, weight loss of 25 lbs over six months, polyuria, and polydipsia. Work up showed hyperandrogenism [total testosterone (T) 450(2-45ng/dl); free T 25.6(0.2-5.0pg/mL)] and hyperglycemia (fasting glucose 265mg/dl). Pelvic ultrasound revealed enlarged ovaries. Ovarian venous sampling demonstrated T >1500ng/dL bilaterally. To suppress T, leuprolide depot injection 11.25mg was empirically given. Within weeks, the patient noted a dramatic improvement in her symptoms, glycemic control, and skin color.
The patient was referred to the National Institutes of Health 3 months after leuprolide. Physical exam revealed extensive acanthosis of the face and extensor surfaces, coarse facial features and generalized loss of fat. BMI was 19.7kg/m2. Labs showed a suppressed gonadotropic axis [LH 0.4U/L; FSH 2.1U/L; total T <20.0(<81ng/dl)], euglycemia [fasting glucose 62mg/dl; insulin 29.3(6-27mcU/ml)] and a lipid profile [Cholesterol 142mg/dl; Trig 56mg/dl; HDL 123mg/dl; LDL-C 8mg/dl] suggestive of hypobetalipoproteinemia. Immune tests were consistent with mixed connective tissue disease. Patient was lost to follow up and labs 18 months later redemonstrated hyperandrogenic state [LH 8.7U/L; FSH 5.9U/L; total T 476ng/dl], hyperglycemia [fasting glucose 122mg/dl; insulin 279.6] and lipid profile [Cholesterol 116mg/dl; Trig 44mg/dl; HDL 76mg/dl; LDL-C 31mg/dl; FFA 0.49(0.1-0.8mEq/L);ApoB 33(55-125mg/dl)].
Conclusion: This is a unique case of TBIR with hyperandrogenism and hyperglycemia that improved after leuprolide depot. The reduction in androgens after leuprolide suggest that gonadotropins may play a permissive role in stimulation of ovarian androgen production by insulin. Alternatively, this patient’s simultaneous reduction in both insulin resistance and hyperandrogenism could represent a spontaneous remission of TBIR that coincided with leuprolide administration.
Disclosure: PG: Employee, Amylin Pharmaceuticals. Nothing to Disclose: APD, JJ, MN, RJB
*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm
See more of: Abstracts - Orals, Featured Poster Presentations, and Posters