Abstract
A 13½ year old female presented with primary amenorrhea, weight gain and hirsutism. Examination revealed a mildly obese adolescent with a deep voice, facial and truncal hirsutism, and acanthosis nigricans in axillae and popliteal fossae. Sexual development was Tanner stage V and clitoral size 8×15 mm. The left ovary was enlarged to palpation.Laboratory evaluation revealed a bone age of 15 years, elevation of serum testosterone and androstenedione and decrease of sex hormone binding globulin (SHBG) (Table). Pelvic ultrasound showed a cystic left ovary; laparoscopy confirmed bilateral polycystic ovaries. A glucose tolerance test showed fasting, peak and 5 hr blood glucoses of 157, 305 and 242 mg/dl, respectively, with insulin levels ranging from 144 uU/ml fasting to > 400uU/ml.The patient was placed on a combination of mestranol 50ug + norethindrone 1 mg daily and spironolactone 25 mg bid. Elevated androgen levels returned to normal and SHBG returned to near normal by 6 months of therapy and remained normal at 2 years. Facial hirsutism improved dramatically in 6 months of therapy and remains under control at 2 years.
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