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OVARIAN PATHOLOGY ASSOCIATED WITH INSULIN RESISTANCE AND ACANTHOSIS NIGRICANS

From the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts

Abstract

Insulin resistance and the skin lesions of acanthosis nigricans are not commonly seen by the gynecologist, but the ovarian pathology that can be associated with insulin resistance and acanthosis nigricans is well known. The clinical course of disease in a patient with virilization-amenorrhea associated with insulin resistance and acanthosis nigricans is presented to illustrate the association. Hyperthecosis was the ovarian pathology demonstrated; testosterone levels were in excess of 400 ng/dl. Postoperative testosterone levels were normal at 62 ng/dl. Additional ovarian pathology reported in association with insulin resistance and acanthosis nigricans includes polycystic ovary disease alone, in association with stromal Iuteomas, or with bilateral dermoid cysts. Furthermore, masculinizing ovarian neoplasms such as hilar cell tumors have been reported in association with ovarian hyperthecosis. When evaluating patients with androgen excess, it would be worthwhile to keep in mind the association with abnormal carbohydrate metabolism and acanthosis nigricans.