A CASE OF SEVERE HYPERANDROGENISM, ACANTHOSIS NIGRICANS AND OVERT DIABETES - THE USE OF NONINVASIVE METHODS FOR DIAGNOSIS, PATHOGENESIS ANDMANAGEMENT

Hyperandrogenism is characterized clinically by hirsutism, acne, andro gens-dependent alopecia and elevated serum concentrations of androgens (testosterone and androstenedione). Polycystic ovary syndrome is the most frequent cause of hyperandrogenism. Nevertheless, the differentia l diagnosis includes androgen-secreting tumors of the ovary or adrenal gland. Although rare, it is important to consider this diagnosis inpa tients with serum testosterone concentrations greater than 7 nmol/l. A 35-year-old woman who presented with hirsutism, amenourhea and acanth osis nigricans is described. The endocrine abnormalities included a se rum testosterone concentration of 9 nmol/l and overt type II diabetes mellitus. Imaging studies, including magnetic resonance imaging and Do ppler ultrasonography, did not disclose a secreting tumor. After cypro terone acetate was prescribed the serum testosterone concentration ret urned to normal. The recent application of modern, high-resolution dia gnostic ultrasonography and magnetic resonance imaging enabled a morph ologically based diagnosis iii a case of severe hyperandrogenism with no need for invasive procedures. The therapeutic response to antiandro gens is reassuring.