Cases reported "Hyperinsulinism"

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1/9. Ovarian responses to hCG stimulation: insulin resistance/hyperinsulinaemia vs. insulin deficiency.

    polycystic ovary syndrome is a heterogeneous disorder characterized by signs and symptoms of hyperandrogenism and insulin resistance. We present the clinical and hormonal features in an adolescent girl who had distinct intervals of insulin deficiency and insulin resistance/hyperinsulinaemia. This case report confirms that insulin resistance/hyperinsulinaemia exacerbates ovarian hyperandrogenism.
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ranking = 1
keywords = ovary syndrome, ovary
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2/9. Clinical presentation of PCOS following development of an insulinoma: case report.

    A 24 year old woman presented with a prolonged clinical history of fasting and exertional hypoglycaemia, and was subsequently diagnosed with an insulinoma. Concurrent symptoms of oligomenorrhoea and hyperandrogenism of similar duration were noted. Biochemically, hyperinsulinaemia was observed in association with a raised serum luteinizing hormone (LH), raised testosterone and androstendione concentrations. Surgical removal of the insulinoma resulted in resolution of the clinical and biochemical features of the polycystic ovarian syndrome (PCOS) but minimal change was observed in the ovarian ultrasound appearances. This case demonstrates the role of insulin in mediating the hypersecretion of both LH and androgens in women with polycystic ovaries. We suggest that hyperinsulinaemia converted occult 'polycystic ovaries' to become clinically manifest as 'polycystic ovary syndrome'. This paradigm has clear implications for women with insulin dependent diabetes mellitus who presumably have systemic hyperinsulinaemia.
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ranking = 5.9732243429487
keywords = polycystic ovary syndrome, ovary syndrome, polycystic ovary, polycystic, ovary
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3/9. Endometrial adenocarcinoma and polycystic ovary syndrome: risk factors, management, and prognosis.

    This report presents the development of endometrial adenocarcinoma after diagnosis of polycystic ovary syndrome (PCOS) in three premenopausal women. Such cases illustrate the increased potential for endometrial hyperplasia and malignancy in the setting of chronic anovulation associated with PCOS and underscore the need for prompt identification and treatment. attention to endometrial thickness (as measured by transvaginal sonogram) and elevated insulin level (as measured by fasting plasma insulin) can improve clinical surveillance of both conditions and preserve reproductive potential for women with PCOS.
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ranking = 29.732238653142
keywords = polycystic ovary syndrome, ovary syndrome, polycystic ovary, polycystic, ovary
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4/9. Two hyperandrogenic adolescent girls with congenital portosystemic shunt.

    We describe two adolescent girls with a congenital portosystemic shunt who exhibited hyperandrogenism in addition to insulin resistant hyperinsulinaemia. Case 1 was referred to our clinic to undergo a routine clinical work-up prior to tonsillectomy at 14 years of age. Mild liver dysfunction was identified and hypogenesis of the portal vein with a congenital portosystemic shunt diagnosed. Primary amenorrhoea and virilization were evident and an endocrinological evaluation revealed hyperandrogenism and insulin resistant hyperinsulinaemia. Case 2 was referred at 15 years of age because of cardiomegaly. Mild liver dysfunction and hyperbilirubinaemia led to a diagnosis of agenesis of the portal vein with a congenital portosystemic shunt. Virilization was evident and an endocrinological evaluation revealed hyperandrogenism and insulin resistant hyperinsulinaemia. The haemodynamics of these patients were similar to those of secondary portosystemic shunt due to liver cirrhosis, which is often associated with hyperinsulinaemia and/or non-insulin dependent diabetes mellitus. On the other hand, hyperandrogenism is associated with certain insulin-resistant conditions with hyperinsulinaemia, including the polycystic ovary syndrome (PCO). Hyperinsulinaemia is believed to cause hyperandrogenism in patients with PCO by stimulating androgen production in both the ovary and adrenal gland. Therefore, in congenital portosystemic shunts, hyperinsulinaemia is also thought to cause hyperandrogenism due to the same mechanism. CONCLUSION: A certain percentage of female patients with hyperandrogenism, likely including those with polycystic ovary syndrome may also have congenital portosystemic shunts. Our results indicate that serum levels of total bile acids and ammonia are prognostic indicators of this hepatic vascular anomaly.
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ranking = 11.893658804324
keywords = polycystic ovary syndrome, ovary syndrome, polycystic ovary, polycystic, ovary
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5/9. polycystic ovary syndrome: a case presentation.

    polycystic ovary syndrome (PCOS) is a disorder of excessive adrenal hormone production that results in characteristic features. It is associated with hyperinsulinemia and, if left untreated, carries a risk for developing such complications as diabetes and heart disease. The clinical features are described here by means of a case presentation. Using the Ferriman-Gallwey score, the degree of hirsutism is identified. Differential diagnoses and recommended treatments are discussed. The role of the advanced practice nurse in the diagnosis and care of patients with PCOS is included.
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ranking = 5
keywords = ovary syndrome, ovary
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6/9. Hyperinsulinemia induced by highly active antiretroviral therapy in an adolescent with polycystic ovary syndrome who was infected with human immunodeficiency virus.

    OBJECTIVE: To report a case of polycystic ovary syndrome (PCOS) in an adolescent infected with human immunodeficiency virus (hiv) and lipodystrophy whose insulin resistance was induced by highly active antiretroviral therapy (HAART). DESIGN: Case report. SETTING: Academic department of pediatrics. PATIENT(S): A 14-year-old vertically hiv-infected adolescent receiving HAART. INTERVENTION(S): Clinical observation, metabolic and endocrinologic assessment, imaging of ovaries by ultrasound, and of intra-abdominal adipose tissue content by magnetic resonance imaging. MAIN OUTCOME MEASURE(S): lipodystrophy, insulin resistance, PCOS. RESULT(S): After 34 months of HAART this adolescent showed lipodystrophy with central obesity and insulin resistance after oral glucose tolerance test (OGTT). Ovaries were normal at ultrasonography. After 56 weeks of HAART, the adolescent showed more severe evidence of lipodystrophy and insulin resistance, and she developed acne, hirsutism, and amenorrhea. The following hormone levels were elevated: FSH 5.9 mUI/mL, LH 15.4 mUI/mL, LH/FSH ratio >2.5, free T 5.6 pg/mL, DHEAS 2,070 ng/mL, androstenedione (A) 3.42 ng/mL; whereas 17-beta-E(2), P, PRL, and free T(4) values were within the normal range. ultrasonography demonstrated a typical polycystic echographic architecture of the ovaries. CONCLUSION(S): lipodystrophy and insulin resistance are well-recognized side effects of HAART. polycystic ovary syndrome might be an additional side effect secondary to insulin resistance and lipodystrophy.
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ranking = 30.741164190582
keywords = polycystic ovary syndrome, ovary syndrome, polycystic ovary, polycystic, ovary
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7/9. Longitudinal metabolic observation of metformin effects during pregnancy in hyperinsulinemic women with polycystic ovary syndrome: a case report.

    Obese hyperinsulinemic women with polycystic ovary syndrome (PCOS) present a markedly increased risk of developing glycaemic alterations during pregnancy, commonly recognized as a "diabetogenic" condition. This risk seems to be safely reduced by the administration of metformin during gestation. We analyzed the metabolic changes in two hyperinsulinemic PCOS women, who became pregnant after 8 weeks of metformin therapy and continued taking the drug till delivery. An oral glucose tolerance test and an euglycemic hyperinsulinemic clamp were performed at baseline and, during metformin therapy, in pre-conceptional state and at each trimester of gestation. A pronounced decrease in peripheral insulin sensitivity occurred as the pregnancies proceeded (at the third trimester 51.7% and 41.1% of pregestational values in patient 1 and 2 respectively), along with an increase in stimulated insulin secretion (at the third trimester 120% and 50.6% of pregestational values in patient 1 and 2 respectively). Despite these findings, none of the studied subjects developed gestational diabetes or impaired glucose tolerance. This confirms that metformin may exert a protective role against such disturbances in hyperinsulinemic PCOS patients, probably by avoiding the gestational physiologic changes leading to a loss of the metabolic balance achieved by these subjects out of pregnancy.
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ranking = 29.732238653142
keywords = polycystic ovary syndrome, ovary syndrome, polycystic ovary, polycystic, ovary
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8/9. insulin resistance with acanthosis nigricans and acral hypertrophy.

    Two patients are described with obesity, acanthosis nigricans, acral hypertrophy, basal hyperinsulinism and exaggerated insulin responses to oral glucose. One patient, a diabetic female showed features of virilisation due to polycystic ovarian disease and underwent gonadectomy with some resolution of her androgenisation and acanthosis nigricans. Binding of labelled insulin to erythrocytes was significantly decreased in both patients compared with normal or obese control subjects. In contrast, the receptor concentration in adipose tissue obtained from the patient undergoing gonadectomy was higher than seen in obese control subjects. Thus, somatic growth may be stimulated by insulin in some tissues in these hyperinsulinaemic patients due to relative preservation of receptor numbers.
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ranking = 0.0089255374401415
keywords = polycystic
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9/9. Strumal carcinoid of the ovary associated with hyperinsulinaemic hypoglycaemia and cutaneous melanosis.

    Using immunohistochemical techniques ovarian carcinoid tumours can be shown to contain a wide variety of neuro-hormonal peptides but clinical effects, apart from the carcinoid syndrome, are very rare. Non-islet cell tumours with documented hyperinsulinaemic hypoglycaemia are also rare. This is the first recorded case of an ovarian strumal carcinoid associated with hyperinsulinaemic hypoglycaemia. Concurrent skin hyperpigmentation is believed to have resulted from the effects of tumour derived alpha-melanocyte stimulating hormone or an antigenically similar, biologically active peptide.
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ranking = 0.0030533722702629
keywords = ovary
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