A boy, aged 66 days, was admitted to the hospital due to subcutaneous nodules for 46 days and abdominal distension for 10 days. The main clinical manifestations were loss of adipose tissue, subcutaneous nodules, insulin-resistant diabetes, hypertriglyceridemia, and hepatic steatosis. The boy was diagnosed with congenital generalized lipodystrophy type 1 (CGL1). His condition was improved after administration of middle-chain fatty acid formula milk and insulin injection or oral metformin. Gene testing revealed a homozygous mutation, c.646A>T, in the AGPAT2 gene, and both his parents were carriers of this mutation. This case of CGL1 has the youngest age of onset ever reported in China and multiple subcutaneous nodules as the initial symptom.
Adipose Tissue ; China ; Fatty Liver ; Humans ; Infant ; Insulin Resistance ; Lipodystrophy ; Lipodystrophy, Congenital Generalized ; Male

In the current era of effective antiretroviral therapies (ARTs), human immunodeficiency virus (HIV) infection became a chronic disorder that requires long term follow-up. Among other medical issues, these patients may develop endocrine problems, specific to HIV infection and its treatment. The purpose of this review is to give an overview of common endocrine complications associated with HIV infection, and to propose diagnostic and therapeutic strategies. HIV can affect the endocrine system at several levels. Adrenal and gonadal dysfunction, osteoporosis with increased fracture risk, dyslipidemia with increased cardiovascular risk, are some of the endocrine disorders prevalent in HIV-infected patients that may negatively influence quality of life, and increase morbidity and mortality. While ARTs have dramatically increased life expectancy in the HIV-infected population, they are not devoid of adverse effects, including endocrine dysfunction. Physicians caring for HIV-infected patients should be knowledgeable and exercise a high index of suspicion for the diagnosis of endocrine abnormalities, and in particular be aware of those that can be life threatening. Endocrine evaluation should follow the same strategies as in the general population, including prevention, early detection, and treatment.
Anti-Retroviral Agents ; Diabetes Mellitus ; Diagnosis ; Dyslipidemias ; Endocrine System Diseases ; Endocrine System ; Follow-Up Studies ; Gonads ; HIV Infections ; HIV ; HIV-Associated Lipodystrophy Syndrome ; Humans ; Hyperlipidemias ; Life Expectancy ; Mortality ; Osteoporosis ; Quality of Life

SHORT syndrome is an extremely rare congenital condition due to a chromosomal mutation of the PIK3R1 gene found at 5q13.1. SHORT is a mnemonic representing six manifestations of the syndrome: (S) short stature, (H) hyperextensibility of joints and/or inguinal hernia, (O) ocular depression, (R) Rieger anomaly, and (T) teething delay. Other key aspects of this syndrome not found in the mnemonic include lipodystrophy, triangular face with dimpled chin (progeroid facies, commonly referred to as facial gestalt), hearing loss, vision loss, insulin resistance, and intrauterine growth restriction (IUGR). 3q duplication syndrome is rare syndrome that occurs due to a gain of function mutation found at 3q25.31-33 that presents with a wide array of manifestations including internal organ defects, genitourinary malformations, hand and foot deformities, and mental disability. We present a case of a 2 year and 3 month old male with SHORT syndrome and concurrent 3q duplication syndrome. The patient presented at birth with many of the common manifestations of SHORT syndrome such as bossing of frontal bone of skull, triangular shaped face, lipodystrophy, micrognathia, sunken eyes, and thin, wrinkled skin (progeroid appearance). Additionally, he presented with findings associated with 3q duplication syndrome such as cleft palate and cryptorchidism. Although there is no specific treatment for these conditions, pediatricians should focus on referring patients to various specialists in order to treat each individual manifestation.
Chin ; Cleft Palate ; Cryptorchidism ; Depression ; Facies ; Fetal Growth Retardation ; Foot Deformities ; Frontal Bone ; Hand ; Hearing Loss ; Hernia, Inguinal ; Humans ; Insulin Resistance ; Joints ; Lipodystrophy ; Male ; Micrognathism ; Parturition ; Skin ; Skull ; Specialization ; Tooth ; Tooth Eruption

Congenital lipodystrophic diabetes (CLD) is a rare genetic disease characterized by generalized or topical subcutaneous fat loss combined with various metabolic disorders such as insulin resistance, dyslipidemia, and impaired glucose tolerance. Recent studies have discovered genes underlying the disease. Mutations of such genes are associated with adipogenic anomaly, especially regulational function of peroxisome proliferators-activated receptor γ (γPPAR) for lipid. This paper has provided a review for the main clinical symptoms, classification, pathogenic genes, molecular mechanism and the relationship between PPARγ and fat loss.
Cell Differentiation ; Diabetes Mellitus ; genetics ; Humans ; Insulin Resistance ; Lipodystrophy, Congenital Generalized ; genetics ; PPAR gamma ; genetics ; Transcription Factors

Barraquer-Simons syndrome is a rare acquired lipodystrophy characterized by gradually symmetric subcutaneous fat loss in a craniocaudal distribution, often associated with hypocomplementemia and nephropathies. Facial cosmetic treatment in this disorder has not been fully described in the literature. We present a patient with Barraquer-Simons syndrome with emphasis on early cosmetic intervention with autologous fat grafting and its long-term efficacy. At the follow-up 37 months after the last fat grafting, preservation of the grafted fat was noted while lipodystrophy progressed in the trunk regions. Autologous fat grafting is suggested for the correction of facial dysmorphism in this type of lipodystrophy.
Autografts ; Follow-Up Studies ; Humans ; Lipectomy ; Lipodystrophy* ; Subcutaneous Fat ; Transplants

A girl, aged 1 year and 9 months, was found to have hypertriglyceridemia in the neonatal period, with unusual facies and signs of dark skin all over the body, disappearance of subcutaneous adipose, acanthosis nigricans of the neck, excessive and thick hair, empty cheeks, muscle hypertrophy of the extremities, hepatomegaly, and neutrophil deficiency. Whole exome sequencing of monogenic disorder revealed a homozygote mutation in the BSCL2 gene, c.974 (exon 7)_c.975 (exon 7) insG. Her parents were heterozygotes for this locus. The girl was diagnosed with congenital generalized lipodystrophy (CGL), but the association between CGL and neutrophil deficiency remained unclear. Triglyceride was maintained at a normal level after the treatment with a low-fat and high-carbohydrate diet, and there were no obvious changes in signs. CGL is a rare autosomal recessive systemic disease manifested as disappearance of systemic subcutaneous adipose, muscle hypertrophy of the extremities, and metabolic disorders in the neonatal period, such as high triglycerides, hyperinsulinemia, and hyperglycemia. About 95% of CGL cases are caused by mutations in the AGPAT2 or BSCL2 gene.
Facies ; Female ; GTP-Binding Protein gamma Subunits ; Humans ; Hypertriglyceridemia ; Infant ; Lipodystrophy, Congenital Generalized

Acquired partial lipodystrophy, also known as Barraquer-Simons syndrome, is a rare disease characterized by progressive atrophy of adipose tissue primarily on the face, leading to a gaunt appearance. Usually manifesting in childhood and in women, the evolution of fat loss occurs in a cephalocaudad manner. The lower extremities are spared and may present with paradoxical hypertrophy. Common findings are C3 hypocomplementemia and positive C3 nephritic factor (C3Nef) but the pathogenesis remains unknown. The prognosis depends on presence of co-morbidities such as membranoproliferative glomerulonephritis. We report a 41-year-old woman who presented with a 23 year history of progressive fat atrophy on the face, trunk, and upper extremities with no skin changes or other symptoms. Subsequently, a three-year history of fat hypertrophy in both lower extremities was noted. Histopathologic findings and decreased C3 ultimately led to a diagnosis of acquired partial lipodystrophy. A thorough approach to this case is reported, along with a review of current literature on pathogenetic mechanisms suspected in the disease. Amongst the lipodystrophy syndromes, acquired partial lipodystrophy portends a relatively good prognosis. However, the cosmetic disfigurement and risk for membranoproliferative glomerulonephritis necessitate a multidisciplinary form of supportive management from a medical, surgical, and psychological point of view. With watchful supportive therapy, patients may lead normal, fulfilling lives.

Human ; Female ; Adult ; Adipose Tissue ; Atrophy ; Complement C3 Nephritic Factor ; Glomerulonephritis, Membranoproliferative ; Hypertrophy ; Lipodystrophy ; Lower Extremity ; Skin ; Torso

Abdomen ; Child, Preschool ; Female ; Human Growth Hormone ; deficiency ; Humans ; Lipodystrophy ; etiology

Berardinelli-Seip congenital lipodystrophy 2 (BSCL2) gene is known to be associated with different clinical phenotypes; Silver syndrome, Charcot-Marie-Tooth type 2 with a dominant hand involvement and distal hereditary motor neuropathy type V (dHMN-V). Up to now, only two heterozygous mutations (N88S and S90L) in BSCL2 have been reported. We identified a N88S BSCL2 mutation in a dHMN-V family with a spastic gait by whole-exome sequencing. To our knowledge, this is the first report of a N88S BSCL2 mutation in Korean patient.
Exome ; Gait Disorders, Neurologic ; Hand ; Humans ; Lipodystrophy, Congenital Generalized ; Silver ; Spastic Paraplegia, Hereditary

Leptin, an adipocyte-secreted hormone, regulates energy homeostasis as well as reproductive, neuroendocrine, immune and metabolic functions. Subjects with decreased amounts of fat in their adipose tissue, i.e., lipoatrophy, have low leptin levels. In the context of open-label, uncontrolled studies leptin administration, in physiological replacement doses, has been shown to have metabolically salutary effects in the rare patients with the syndrome of congenital lipodystrophy accompanied by leptin deficiency. Much more patients with lipodystrophy suffer from lipodystrophy and the metabolic syndrome associated with the use of highly active antiretroviral therapy. In this so called highly active antiretroviral therapy (HAART)-associated lipodystrophy and metabolic syndrome, patients demonstrate fat maldistribution with dyslipidemia, insulin resistance, and other metabolic complications. Leptin administration has been shown to decrease central fat mass and to improve fasting insulin/glucose levels and insulin sensitivity in human immunodeficiency virus-infected hypoleptinemic patients with HAART induced lipodystrophy and the metabolic syndrome. By contrast, the results of leptin treatment in leptin replete or hyperleptinemic obese individuals with glucose intolerance and diabetes mellitus have been minimal or null, presumably due to leptin tolerance or resistance that impairs leptin action. In this review, we present the emerging clinical applications and potential therapeutic uses of leptin in humans with lipodystrophy and the metabolic syndrome.
Adipose Tissue ; Antiretroviral Therapy, Highly Active ; Diabetes Mellitus ; Dyslipidemias ; Fasting ; Glucose Intolerance ; HIV ; Homeostasis ; Humans ; Insulin Resistance ; Leptin ; Lipodystrophy ; Therapeutic Uses