INS and acanthosis nigricans: RMS was suspected in this patient because of the classical facial features, presence of exuberant scalp hair and hirsutism, typical dental abnormalities, growth retardation, acanthosis nigricans, lack of subcutaneous fat (lipoatrophy), hyperandrogenism, enlargement of external genitalia (clitoromegaly), extremely elevated levels of circulating insulin and also presence of other supportive biochemical parameters.