Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age. PCOS has a typical presentation with obesity, hirsutism, and menstrual irregularity but can also be associated with insulin resistance and an increased risk of type 2 diabetes mellitus. This report presents the case of a 24-year-old underweight woman with a body mass index (BMI) of 15.9 kg/m2 with insulin resistance, hirsutism, and a diagnosis of PCOS. CASE REPORT A 24-year-old woman presented with hyperandrogenic signs, hirsutism, acne, and irregular menstrual cycles. During the clinical examination, acne vulgaris on the face was recorded, but not alopecia or acanthosis nigricans. Blood pressure was 110/70 mmHg, WHR (waist-to-hip-ratio)=87 and BMI (body mass index)=15.9. Ferriman-Gallwey's scoring system was used to assess for hirsutism. All hematological and biochemical results were normal. Hormonal tests revealed elevated testosterone, androstenedione, and 17-OH progesterone levels, confirming the diagnosis. Conditions such as Cushing's syndrome, hyperprolactinemia, and thyroid disorders were excluded based on normal levels of adrenocorticotropic hormone, cortisol, prolactin, triiodothyronine, thyroxine, and thyroid-stimulating hormone. Despite the patient's underweight status, insulin resistance was identified with OGTT (oral glucose tolerance test), making it the primary treatment target. Treatment addressed the underlying pathology with metformin and dexamethasone. Significant improvement in menstrual cycle, acne, and hirsutism was observed after 6 months. CONCLUSIONS This report has highlighted that when patients with PCOS also have insulin resistance, they may be of normal weight or underweight and require a multidisciplinary approach to diagnosis and management.