05 September 2026
: Case report 
Primary Care Recognition of Rabson-Mendenhall Syndrome Despite Absence of Classical Diabetic Symptoms
Challenging differential diagnosis, Rare disease
Abdullah Al Eisa ABE 1, Atheer Humoud Aldayhani ABDEF 2*DOI: 10.12659/AJCR.953067
Am J Case Rep 2026; 27:e953067
Table 2 Chronological timeline of clinical course and treatment.
| Time period in clinical course | Clinical findings | Treatment modification | Clinical course / outcome |
|---|---|---|---|
| ~ 2 years before presentation | Progressive skin darkening and excessive hunger | No formal diagnosis established | Symptoms gradually progressed |
| 1 month before clinic visit | Intermittent bilateral leg and foot pain became prominent | Family sought medical care | Clinical evaluation prompted by leg and foot pain |
| Initial family medicine assessment | Acanthosis nigricans, hirsutism, deep voice, dental findings, severe hyperinsulinemia, and endocrine abnormalities identified | Laboratory investigations + therapeutic vitamin D + pediatric endocrinology referral | Metabolic/endocrine disorder suspected |
| Early endocrine and genetic evaluation (within weeks following initial assessment) | Severe insulin resistance and hyperandrogenic features persisted | Multidisciplinary assessment involving endocrinology, genetics, and dermatology | Genetic insulin resistance suspected |
| Early endocrine follow-up, 1 month after initial assessment | Persistent hyperglycemia and elevated HbA1c | Metformin 500 mg twice daily initiated | Glycemic management started |
| Follow-up at approximately 8 months after initial assessment | HbA1c remained elevated | Metformin titrated to 1000 mg twice daily | Gastrointestinal intolerance required dose adjustment and re-titration |
| Follow-up at approximately 15 months after initial assessment | Persistent severe insulin resistance and inadequate glycemic control | Basal-bolus insulin therapy (insulin degludec + insulin aspart) | Limited glycemic improvement despite escalation |
| Long-term follow-up, approximately 2 years after initial assessment | Persistent suboptimal glycemic control | Dapagliflozin 5 mg once daily added | Continued close monitoring and treatment intensification |
| Most recent documented follow-up, approximately 3 years after initial assessment | Persistent severe insulin resistance | Metformin 1000 mg twice daily + insulin degludec + insulin aspart + dapagliflozin 5 mg | Ongoing multidisciplinary follow-up through family medicine and pediatric endocrinology |