Lipodystrophy at a Glance
- Lipodystrophies are genetic or acquired disorders characterized by selective loss of body fat. The extent of fat loss determines the severity of associated metabolic complications such as diabetes mellitus, hypertriglyceridemia, hepatic steatosis, and acanthosis nigricans.
- Four loci have been identified for the autosomal recessive congenital generalized lipodystrophy (CGL), namely, (1) AGPAT2, (2) BSCL2, (3) CAV1, and (4) PTRF.
- Four loci have been identified for autosomal dominant familial partial lipodystrophy (FPL), namely, (1) LMNA, (2) PPARG, (3) AKT2, and (4) PLIN1.
- CIDEC is the locus for autosomal recessive FPL, and LMNA and ZMPSTE24 are loci for autosomal recessive mandibuloacral dysplasia-associated lipodystrophy.
- Molecular basis of many rare forms of genetic lipodystrophies remains to be elucidated.
- The most prevalent variety of lipodystrophy develops after prolonged duration of protease inhibitor containing highly active antiretroviral therapy in HIV-infected patients.
- The acquired generalized lipodystrophy and acquired partial lipodystrophy are mainly autoimmune in origin.
- Localized lipodystrophies occur due to drug or vaccine injections, pressure, panniculitis, and other unknown reasons.
- The current management includes cosmetic surgery and early identification and treatment of metabolic and other complications.
Lipodystrophies are a heterogeneous group of disorders characterized by selective loss of adipose tissue.1 The extent of fat loss varies, with some patients losing fat from small areas (localized lipodystrophy), whereas others may have more extensive fat loss, for example, involving the extremities (partial lipodystrophy) or the entire body (generalized lipodystrophy). Depending upon the extent of fat loss, patients may be predisposed to develop complications associated with insulin resistance such as, diabetes mellitus, dyslipidemia, hepatic steatosis, acanthosis nigricans, polycystic ovarian disease, and coronary heart disease.2,3 There are two main types of lipodystrophies: (1) genetic and (2) acquired. A detailed classification of various types of lipodystrophies is given in Table 71-1.
Table 71-1 Classification of Lipodystrophies |Favorite Table|Download (.pdf)
Table 71-1 Classification of Lipodystrophies
Autosomal recessive, congenital generalized lipodystrophy (CGL)
Type 1: AGPAT2 mutations
Type 2: BSCL2 mutations
Type 3: CAV1 mutation
Type 4: PTRF mutations
Autosomal dominant, familial partial lipodystrophy (FPL)
Dunnigan variety: LMNA mutations
d. PLIN1 mutations
Autosomal recessive, familial partial lipodystrophy
Autosomal recessive, mandibuloacral dysplasia (MAD)-associated lipodystrophy
Other lipodystrophies associated with LMNA mutations
Atypical progeroid syndrome
Hutchinson–Gilford progeria syndrome
Neonatal progeroid (Weidemann–Rautenstrauch) syndrome
Mandibular hypoplasia, deafness, progeroid (MDP) syndrome
Joint contractures, microcytic anemia, panniculitis-associated (JMP) lipodystrophy syndrome spectrum
- 9a. Chronic atypical neutrophilic dermatosis with ipodystrophy and elevated temperature (CANDLE) syndrome
Highly active antiretroviral therapy-induced lipodystrophy in HIV-infected patients
Acquired generalized lipodystrophy
Acquired partial (Barraquer–Simons) lipodystrophy
In the last decade or so, considerable progress has been made in elucidation ...