Diabetes in a Bearded Woman

In 2005, a 61-year-old woman was admitted to the hospital with a nonketotic hyperosmolar state and seizures, with a serum glucose level of 800 mg/dL and an HbA1c of 14.1%. Despite no prior history of diabetes, she exhibited virilization symptoms, including a full beard, balding, and increased terminal hair, which had developed over two years. Her testosterone levels were significantly elevated. After poor glycemic control post-discharge, further investigation revealed a 1.3-cm stromal luteoma in her left ovary and stromal hyperthecosis in the right ovary, which were likely the sources of her hyperandrogenism. Postoperative testosterone levels became undetectable, and her diabetes control improved dramatically, allowing a reduction in insulin requirements. The case highlighted the complex relationship between hyperandrogenism and insulin resistance in women, suggesting that functional ovarian tumors causing hyperandrogenism can lead to insulin resistance and diabetes, a contrast to the association of low androgen levels with insulin resistance in men.