title: A case of lean polycystic ovary syndrome with early stage of type 1 diabetes successfully treated with metformin.
abstract: Polycystic ovary syndrome (PCOS) is common in obese women with insulin resistant type 2 diabetes for which metformin treatment is getting established in addition to clomiphene. However, lean PCOS patients are sometimes accompanied with type 1 diabetes. It remains unclear whether these patients are insulin resistant and whether metformin is effective for them. A 32-year-old woman, who suffered from acne, hirsutism, and menstrual disorders since age 29, was diagnosed as PCOS by serum high LH levels and polycystic ovary on echography. Interestingly, her body mass index (BMI) had consistently been 21.0 kg/m2 since age 20. She was first treated with clomiphene for one year for infertility but it did not improve her menstrual cycle nor did she get pregnant during that period. She was then assessed with diabetes mellitus and subsequently diagnosed as type 1 diabetes with mild hyperglycemia (HbA1c 6.0%). Since her insulin secretion was still well preserved, to assess insulin sensitivity, hyperinsulinemic-euglycemic clamp test was performed and showed her to be insulin resistant. Low dose insulin and low dose metformin treatment was started without clomiphene. After her ovulation and menstrual cycle were ameliorated only one month later, her treatment was supplemented with clomiphene for the next three months enabling her to at last become pregnant. This report highlights the efficacy of metformin in lean PCOS with type 1 diabetes. Insulin therapy is essential for type 1 diabetes but hyperinsulinemia potentially exacerbates PCOS through hyperandrogenism. Metformin is therefore recommended for treatment of lean PCOS with type 1 diabetes as well as common obese PCOS with type 2 diabetes.
authors.affiliation: Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan.
authors.forename: Fumika
authors.initials: F
authors.lastname: Shigiyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Kumashiro
authors.forename: Takayuki
authors.initials: T
authors.lastname: Rikitake
authors.forename: Shuki
authors.initials: S
authors.lastname: Usui
authors.forename: Michiko
authors.initials: M
authors.lastname: Saegusa
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kitamura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uchino
authors.forename: Takahisa
authors.initials: T
authors.lastname: Hirose
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D013851:Thinness / Q000150:complications / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin