Type B Insulin Resistance Resulting in Hyperthecosis in a Postmenopausal Woman

A 49-year-old African American woman developed type B insulin resistance at age 45, requiring up to 1800 units of insulin daily. She also experienced oligomenorrhea, excessive hair growth, and elevated serum testosterone levels. Treatment with rituximab, dexamethasone, and cyclophosphamide significantly reduced her insulin needs, but her testosterone levels remained high, indicating persistent hyperandrogenism. Postmenopausal status was confirmed by elevated serum FSH levels, and imaging revealed ovarian abnormalities. The case suggested that high insulin levels stimulated ovarian thecal cells, leading to hyperthecosis, and the patient was referred for bilateral oophorectomy.