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 β-human chorionic gonadotropin (β-HCG). With treatment of her ovarian tumor and normalization of the serum β-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 β-HCG and possibly other placental hormones from the germ cell tumor caused her to develop insulin resistance and inadequate β-cell insulin secretory response.