High serum testosterone concentrations in a diabetic woman with end-stage renal disease.

A simultaneous pancreas--kidney transplant (SPK) is indicated in patients with type 1 diabetes (T1D) and end-stage renal disease. In patients with type 2 diabetes (T2D) it is not generally indicated,1 because steroid and immunosuppression treatment exacerbates insulin resistance and weight gain. However, in carefully selected patients with T2D who are not obese, SPK results may be similar to those observed in T1D.2 Experiences with other types of diabetes are seldom reported although one study showed a favorable outcome in monogenic diabetes due to mutations in the HNF1A gene.3 The potential candidates for an SPK should be evaluated for any existing neoplasias which would contraindicate the transplant. In women with hyperandrogenism, tumors are rarely the underlying cause, but ruling them out is considered necessary, especially in cases in which clinical and analytical data, such as notably high levels of androgens, are observed. We report the case of a patient with diabetes and endstage renal disease who presented high serum testosterone levels during pre-transplant evaluation. A 32-year-old woman with a 16-year history of diabetes on insulin treatment presented moderate diabetic retinopathy and end-stage diabetic nephropathy for the previous 3 years. Several members of her family had also been diagnosed with diabetes: her father was diagnosed at the age of 30, received insulin treatment and had renal impairment; her mother, her maternal grandmother and a paternal aunt were on hypoglycemic oral agents. The patient used pre-mixed insulins (30/70) at breakfast and dinner and aspart insulin at lunch. This regime was modified to a basal-bolus scheme with glargine and aspart insulins. She also took candesartan, atorvastatin, calcitriol, omeprazole, amitriptyline and flunarizine.