Clinical presentation of PCOS following development of an insulinoma

A 24 year old woman presented with a prolonged clinical history of fasting and exertional hypoglycaemia, and was subsequently diagnosed with an insuli noma. Concurrent symptoms of oligomenorrhoea and hyperandrogenism of simila r duration were noted, Biochemically, hyperinsulinaemia was observed in ass ociation with a raised serum luteinizing hormone (LEI), raised testosterone and androstendione concentrations, Surgical removal of the insulinoma resu lted in resolution of the clinical and biochemical features of the polycyst ic ovarian syndrome (PCOS) but minimal change was observed in the ovarian u ltrasound appearances. This case demonstrates the role of insulin in mediat ing the hypersecretion of both LH and androgens in women with polycystic ov aries. We suggest that hyperinsulinaemia converted occult 'polycystic ovari es' to become clinically manifest as 'polycystic ovary syndrome'. This para digm has clear implications for women with insulin dependent diabetes melli tus who presumably have systemic hyperinsulinaemia.