Severe hyperandrogenemia and insulin resistance in a 12-year-old girl.

BACKGROUND

Signs of androgen excess are common complaints of adolescents and young adults. Rapid onset/progression of hyperandrogenism or virilization should prompt further investigation to exclude an androgen-secreting tumor.

CASE

We report the case of an obese young adolescent girl who presented with hirsutism, deepened voice, oligomenorrhea, marked acanthosis nigricans, and rapidly increasing testosterone and insulin levels. Imaging studies were negative for both ovarian and adrenal masses. She was successfully treated with continuous combined oral contraceptives. Investigation, treatment, and outcome are reviewed.

SUMMARY AND CONCLUSION

This case demonstrates that patients with PCOS may present with a testosterone > 200 ng/dL and that severe hyperinsulinemia can be associated with rapid progression of hyperandrogenism.