Acromegaloid bone changes in severe polycystic ovarian disease: an effect of hyperinsulinaemia? Case report

Abstract

A 33-year-old woman presented to the reproductive medicine clinic with amenorrhoea of 14 years' duration together with progressively worsening hirsutism for 8 years, temporal hair loss for 4 years and infertility for 2 years. She had previously failed to respond to clomiphene citrate but was currently receiving no therapy. Her mother had developed diabetes mellitus in late adult life.On examination she was markedly overweight (body mass index 47.2 kg/m) with severe hirsutism and hair loss over the vertex and temporal areas. She had broad hands with thickened skin and acanthosis nigricans of the inner thigh. Her blood pressure was mildly elevated (140/90 mmHg). Abdominal and vaginal examination revealed a pelvic mass. A 13-cm multiloculated cystic lesion arising from the left side of the pelvis was seen on ultrasound scan. The ovaries were not seen separately and there was no ascites. An endocrine profile showed raised serum concentrations of luteinizing hormone (LH) (19 UA), total testosterone (6.2 nmolil) and dehydroepiandrosterone-sulphate (12.3 umoV1), but normal levels of FSH (3.4 UA), prolactin (99 mUA) and free thyroxine (13.9 pmolil). She had an elevated fasting insulin concentration (37 U/I; normal range <15 UA) but normal blood glucose concentrations, both fasting (4.4 mmoyl) and 60 min after a 75 21,485-493. 235-245.ASSOC 70, 919-923.