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Excessive hair growth anywhere on the body.
No HPO annotations are available for this condition.
Age of onset: at birth.
INSR-related severe insulin resistance syndrome (INSR-SIRS) comprises a phenotypic continuum from the severe phenotype of Donohue syndrome to the milder phenotype of Rabson-Mendenhall syndrome (RMS). To date, fewer than 100 individuals have been identified with INSR-SIRS . The following description of the phenotypic features associated with this condition is based on these reports. Table 2. INSR-Related Severe Insulin Resistance Syndrome: Comparison of Phenotypes by Select Features
INSR-related severe insulin resistance syndrome (INSR-SIRS) should be suspected in individuals with the following , , and findings of Donohue syndrome or Rabson-Mendenhall syndrome (RMS).
Clinical Findings
Donohue syndrome
Source: GeneReviews — "INSR-Related Severe Insulin Resistance Syndrome"
No approved treatments are currently available for hypertrichosis. The disease remains an area of unmet medical need.
To establish the extent of disease and needs in an individual diagnosed with INSR-related severe insulin resistance syndrome (INSR-SIRS), the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended.
Table 4.
INSR-Related Severe Insulin Resistance Syndrome: Recommended Evaluations Following Initial Diagnosis
To monitor existing manifestations, the individual's response to supportive care, and the emergence of new manifestations, the evaluations summarized in are recommended [, , , ]. Table 6. INSR-Related Severe Insulin Resistance Syndrome: Recommended Surveillance
1 clinical trial registered, 1 recruiting. Interventions under study include other interventions. Research is primarily sponsored by academic and government institutions.
183 publications have been identified in PubMed for hypertrichosis. Kisho has analyzed 72 by research type. Research spans Case Report / Case Series (33%), Review / Meta-Analysis (28%), and Basic Science / Preclinical (13%).
Research Type | Count | % of Total |
|---|---|---|
Patient case studies | 24 |
Data assembled from 5 of 12 sources · Last updated Sep 20, 2026, 3:06 PM UTC
European rare disease database
Genetic and Rare Diseases Info Center
Feature | Donohue Syndrome | Rabson-Mendenhall Syndrome |
|---|---|---|
Hyperinsulinism | 100% | 100% |
Diabetic ketoacidosis | + | 100% |
Genital enlargement | + | 100% |
Hypothyroidism | + | 50% Growth |
Intrauterine growth deficiency | 100% | + |
Postnatal growth deficiency | 100% | 60%-80% Neurologic |
Hypotonia | 100% | + |
Developmental delay | 100% | 100% |
Intellectual disability | 100% | 50% |
Dysmorphic facial features | 100% | 100% |
Integument abnormalities | 100% | 100% |
Organomegaly | 100% | 60%-80% |
Rectal hypertrophy /or prolapse | 100% | + Based on , , , , , , , + = reported feature; incidence unknown Donohue syndrome is characterized by severe insulin resistance, growth failure, hypotonia, developmental delay, characteristic facies, and organomegaly. Endocrine manifestations. |
Source: GeneReviews — "INSR-Related Severe Insulin Resistance Syndrome"
The differential diagnosis of INSR-related severe insulin resistance syndrome (INSR-SIRS) includes many rare disorders with hirsutism, severe growth deficiency, and developmental delay with other syndromic features, some of which are summarized in . Table 3. Selected Disorders of Interest in the Differential Diagnosis of INSR-Related Severe Insulin Resistance Syndrome
Gene(s)/ Genetic Mechanism | Disorder | MOI | Clinical Features of Disorder |
|---|---|---|---|
Overlapping w/INSR-SIRS | Distinguishing from INSR-SIRS 11p15.5 hypomethylation,maternal UPD7, other causes1 | Silver-Russell syndrome (SRS) | See footnote 1. |
UCP2 | Familial hyperinsulinism (FHI) | ADAR | Congenital hyperinsulinemia; Hypoglycemia (ranging from severe neonatal-onset disease to childhood-onset disease w/mild symptoms in FHI)3 |
Insulin levels are usually much higher in DS/RMS. AGPAT2BSCL2CAV1CAVIN1 (PTRF) | Berardinelli-Seip congenital lipodystrophy (BSCL) (OMIM PS608594) | AR | Congenital hyperinsulinemia; Insulin resistance4; Hepatomegaly (due to hepatic steatosis skeletal muscle hypertrophy in BSCL); Hypertrophic cardiomyopathy5 |
IGF1R | Resistance to insulin-like growth factor 1 (OMIM 270450) | ARAD | IUGR postnatal growth deficiency; Mildly impaired glucose tolerance6; Delayed psychomotor development; Mild dysmorphic features |
Source: GeneReviews — "INSR-Related Severe Insulin Resistance Syndrome"
System/Concern | Evaluation | Comment
| • Assessment by pediatric endocrinologist
Blood glucose monitoring (during fasting after feeding) or continuous glucose monitoring
Measurement of insulin C-peptide levels
Thyroid function tests
Ovarian ultrasound (in females)
|
| Assessment by nutritionist | To assess feeding diet required to achieve normal glucose levels optimal growth
| Developmental assessment |
| • Eval by pediatric cardiologist
Echocardiography
Cardiac MRI if indicated
| • To assess for hypertrophic cardiomyopathy
Note: Novel blood biomarkers incl BNP, NT-proBNP, hs-CRP, hs-cTnT, uric acid are currently being evaluated.
| • Eval by pediatric nephrologist
Serum electrolytes
24-hour urinary calcium
Renal ultrasound
| To assess for abnormal renin-aldosterone system for nephrocalcinosis
| • Liver function tests per gastroenterologist
Abdominal ultrasound to assess liver/spleen
Eval by pediatric gastroenterologist
| To assess for cholestatic liver disease
Assess for rectal prolapse. |
| Consider eval by oral maxillofacial sp...
Source: GeneReviews — "INSR-Related Severe Insulin Resistance Syndrome"
In individuals with Donohue syndrome, avoid the following:
Agents that cause hypoglycemia
Prolonged fasting
Contact with persons with a contagious disease
In individuals with RMS, avoid the following:
Agents that cause hyperglycemia
High-carbohydrate diet
Contact with persons with a contagious disease
Source: GeneReviews — "INSR-Related Severe Insulin Resistance Syndrome"
There are no controlled trials in INSR-SIRS; thus, the two therapies discussed in this section are for individuals with INSR pathogenic variants based on clinical experience, case series, and expert opinion.
The rationale for using rhIGF-1 to treat severe insulin resistance syndromes is based on observations of its direct effects on carbohydrate metabolism. In humans, infusion of rhIGF-1 suppresses hepatic glucose production, stimulates peripheral glucose uptake in muscle, and – despite a significant reduction in circulating insulin levels – causes hypoglycemia. The insulin-like growth factor 1 receptor (IGF1R) and the insulin receptor (INSR) share 60% homology and very similar intracellular activity . Treatment regimen.
Source: GeneReviews — "INSR-Related Severe Insulin Resistance Syndrome"
1 trial found
Evaluation |
|---|
Frequency |
|---|
Endocrine | Capillary glucose levels | During fasting after feeding or when clinically indicated; or continuous glucose monitoring; HbA1c; Insulin C-peptide levels |
Growth | Nutrition growth assessment | At each visit |
Development | Assess psychomotor development. | Every 3 mos |
Immune function | Assess for recurrent infections. | At each visit Cardiac |
Malignancies | Gynecologic eval to assess for endometrial cancer | In those w/abnormal vaginal bleeding HbA1c = glycosylated hemoglobin |
Source: GeneReviews — "INSR-Related Severe Insulin Resistance Syndrome"
Research summaries | 20 | 28% |
Laboratory research | 9 | 13% |
Disease patterns and progression | 8 | 11% |
Other research | 5 | 7% |
Clinical study results | 4 | 6% |
New treatment approaches | 2 | 3% |
Dewey E (2026). [PMID: 41654020](https://pubmed.ncbi.nlm.nih.gov/41654020/). *J Am Acad Dermatol*. [Epidemiology / Natural History]
Jimenez-Cauhe J (2026). [PMID: 40960258](https://pubmed.ncbi.nlm.nih.gov/40960258/). *J Eur Acad Dermatol Venereol*. [Other]
Saleh D (2026). [PMID: 30521275](https://pubmed.ncbi.nlm.nih.gov/30521275/). *Unknown Journal*. [Review / Meta-Analysis]
Iftikhar W (2026). [PMID: 32491654](https://pubmed.ncbi.nlm.nih.gov/32491654/). *Unknown Journal*. [Case Report / Case Series]
Wang K (2026). [PMID: 41608093](https://pubmed.ncbi.nlm.nih.gov/41608093/). *World J Diabetes*. [Case Report / Case Series]
Ong MM (2026). [PMID: 41118052](https://pubmed.ncbi.nlm.nih.gov/41118052/). *American journal of clinical dermatology*. [Review / Meta-Analysis]
Zhang J (2026). [PMID: 40737084](https://pubmed.ncbi.nlm.nih.gov/40737084/). *Clin Exp Rheumatol*. [Epidemiology / Natural History]
Sharma D (2026). [PMID: 41741964](https://pubmed.ncbi.nlm.nih.gov/41741964/). *J Dermatolog Treat*. [Epidemiology / Natural History]
Yan S (2025). [PMID: 40309171](https://pubmed.ncbi.nlm.nih.gov/40309171/). *Front Pediatr*. [Case Report / Case Series]
Abla KK (2025). [PMID: 39835177](https://pubmed.ncbi.nlm.nih.gov/39835177/). *Int J Nanomedicine*. [Case Report / Case Series]