Insulin-mediated pseudoacromegaly and ovarian insufficiency via a single enzymatic defect: a case report

ABSTRACT

Insulin resistance is a condition in which the cells of the body become resistant to the effects of insulin, that is, the normal response to a given amount of insulin is reduced. As a result, higher levels of insulin are needed in order for insulin to exert its effects. Polycystic Ovarian Syndrome (PCOS) is one of the metabolic syndromes that link insulin resistance with diabetes mellitus, hyperandrogenism, and ovulatory dysfunction. PCOS often has a menarcheal age of onset characterized by a failure to establish a regular pattern of menses. In the case presented, the patient has primary amenorrhea assoicated with the development of secondary sexual characteristics, acanthosis nigricans, and acromegaloid attributes. Evaluation of pituitary function revealed that the patient's amenorrhea is secondary to hypergonadotropic hypogonadism, particularly, ovarian insufficiency. This case provides a unique setting to relate the syndrome of insulin-mediated expression of an acromegaloid pnenotype with insulin-mediated pathogenic mecahnisms for ovarian failure to exist concurrently.