At age 16 with secondary amenorrhea, hirsutism, acne, virilization, prompting bilateral ovarian wedge resection. Regular menses thereafter, and 2 successful pregnancies. At age 35 with acromegaloid facies and hands. Diabetes aged 38 with worsening hirsutism, necrobiosis lipoidica and high insulin requirements. Total abdominal hysterectomy and left salpingo-oophorectomy aged 42 for menorrhagia. At age 50 with large right sided pelvic mass with hydronephrosis, liver and pulmonary nodules. Presumed metastatic epithelial ovarian cancer. Died 7 days later. The gene discussed is INS; the disease is necrobiosis lipoidica.