Congenital lipodystrophy (CL) is a group of genetic disorders characterized by an extreme deficiency of fat tissue in the body. The core defect of this disease is adipose metabolism disorder and is associated with a variety of metabolic problems, such as insulin resistance, diabetes, hypertriglyceridemia, and hepatic pathological changes. Over the past few decades, the rapid development of genomics and molecular biology has significantly advanced the identification and functional study of genes related to CL. This article aims to review the recent progress in the identification and function of CL-related genes, deepen the understanding of its pathological mechanisms, and provide references for future treatment strategies.