Insulin resistance associated with androgen excess in women with autoantibodies to the insulin receptor.

Hirsutism, polycystic ovaries, and elevated levels of plasma testosterone are characteristic clinical features in women with extreme insulin resistance and acanthosis nigricans. Extreme insulin resistance resulting from autoantibodies to the insulin receptor (type B extreme insulin resistance) had been considered an exception to this generalization. A woman with type B extreme insulin resistance developed clinical evidence of masculinization in association with a markedly elevated level of plasma testosterone (1000 ng/dL). In nine women with autoantibodies to the insulin receptor, excessive ovarian production of testosterone was a common feature among the premenopausal patients. Postmenopausal patients rarely developed elevated levels of plasma testosterone, presumably as a result of ovarian failure. Overproduction of testosterone may result from a direct effect of hyperinsulinemia on the ovary.