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December 29, 2000

Diagnosis and Symptoms

Question from Miami, Florida, USA:

My 20 year old daughter has acanthosis nigricans on the neck, chests, groin, axillae, and elbows, hirsutism on the neck, abdomen, and chest, well developed muscles despite obesity and a sedentary lifestyle, a slightly enlarged clitoris, and regular menstruations. Last year, an endocrinologist and dermatologist both diagnosed her having pre-diabetes. However, although they took into account the hirsutism and acanthosis nigricans, she was embarrassed to tell them about the musculature and clitoral symptoms. A very recent basic lab work up came back normal, and her glucose was actually low. Her father and paternal grandfather have type�2 diabetes, and I had gestational diabetes. Could she have pre-diabetes? Is it more likely that another, hormonal disorder is at work? What specialist would you recommend that I take her to?

Answer:

Your daughter needs to make an appointment with the same endocrinologist she saw previously, if she trusts that doctor and is willing to tell the whole story. Given the entire story, there are lab tests that need to be considered. These would include androgens of adrenal and ovarian origin. Secondly, the family history and the acanthosis are factors, and so might be her insulin level. It seems to me that a frank visit to a competent physician is the right step. It is difficult to practice medicine without all the details. Encourage her!

LD