title: Hyperinsulinemia induced by highly active antiretroviral therapy in an adolescent with polycystic ovary syndrome who was infected with human immunodeficiency virus.
abstract: OBJECTIVE
  To report a case of polycystic ovary syndrome (PCOS) in an adolescent infected with human immunodeficiency virus (HIV) and lipodystrophy whose insulin resistance was induced by highly active antiretroviral therapy (HAART).
  
  
  METHODS
  Case report.
  
  
  METHODS
  Academic department of pediatrics.
  
  
  METHODS
  A 14-year-old vertically HIV-infected adolescent receiving HAART.
  
  
  METHODS
  Clinical observation, metabolic and endocrinologic assessment, imaging of ovaries by ultrasound, and of intra-abdominal adipose tissue content by magnetic resonance imaging.
  
  
  METHODS
  Lipodystrophy, insulin resistance, PCOS.
  
  
  RESULTS
  After 34 months of HAART this adolescent showed lipodystrophy with central obesity and insulin resistance after oral glucose tolerance test (OGTT). Ovaries were normal at ultrasonography. After 56 weeks of HAART, the adolescent showed more severe evidence of lipodystrophy and insulin resistance, and she developed acne, hirsutism, and amenorrhea. The following hormone levels were elevated: FSH 5.9 mUI/mL, LH 15.4 mUI/mL, LH/FSH ratio >2.5, free T 5.6 pg/mL, DHEAS 2,070 ng/mL, androstenedione (A) 3.42 ng/mL; whereas 17-beta-E(2), P, PRL, and free T(4) values were within the normal range. Ultrasonography demonstrated a typical polycystic echographic architecture of the ovaries.
  
  
  CONCLUSIONS
  Lipodystrophy and insulin resistance are well-recognized side effects of HAART. Polycystic ovary syndrome might be an additional side effect secondary to insulin resistance and lipodystrophy.
authors.affiliation: Chair of Pediatrics, L. Sacco Hospital., University of Milan, Italy. alevig@mailserver.unimi.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Viganò
authors.forename: Paola
authors.initials: P
authors.lastname: Manzoni
authors.forename: Silvia
authors.initials: S
authors.lastname: Riva
authors.forename: Paolo
authors.initials: P
authors.lastname: Brambilla
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrazzi
authors.forename: Marco M
authors.initials: MM
authors.lastname: Marzi
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis* / Q000635:transmission; D006801:Humans; D006946:Hyperinsulinism / Q000139:chemically induced*; D018445:Infectious Disease Transmission, Vertical; D008060:Lipodystrophy / Q000139:chemically induced; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D014463:Ultrasonography