A 24-year-old woman was admitted for investigation following a grand-mal seizure during exercise. Further history revealed 6 months of excessive tiredness, tremors, intermittent episodes of confusion, blurred vision, and perioral paraesthesia. These symptoms were noted to resolve immediately following eating. Additional symptoms of acne, seborrhoea, and mild hirsutism had developed concurrently.
In the 12 months before the presentation, the interval between menstrual periods increased with each cycle, the cycle length at the time of presentation was 40–44 days. Physical examination revealed acne, seborrhoea, and mild hirsutism. Insulin and C-peptide were inappropriately elevated and a diagnosis of an insulinoma was made. Pelvic ultrasonography showed enlarged polycystic ovaries with bilaterally increased stroma and >10 follicles per ovary, ranging in diameter from 4–9 mm. A reproductive endocrine profile revealed raised serum LH and androgen concentrations with normal serum follicle-stimulating hormone (FSH), prolactin, and sex hormone-binding globulin (SHBG) measurements.
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