Ovarian germinoma accelerating the presentation of diabetes mellitus.

A 12-year-old girl presented to the Children's Emergency Department with symptoms of diabetes mellitus. Glutamic acid decarboxylase autoantibodies and anti-Islet cell antibodies were absent. She was also found to have ovarian dysgerminoma with markedly elevated serum ß-human chorionic gonadotropin (ß-HCG). With treatment of her ovarian tumor and normalization of the serum ß-HCG her insulin therapy was quickly discontinued and metformin started. The ovarian dysgerminoma appeared to have accelerated the presentation of severe diabetes. We hypothesized that the elevated ß-HCG and possibly other placental hormones from the germ cell tumor caused her to develop insulin resistance and inadequate ß-cell insulin secretory response.