Underweight and lipodystrophy…a medical conundrum
Introduction: Patient with lipodystrophy is usually underweight, with a body mass index (BMI) of under 18.5 or a weight 15% to 20% below that of normal for age and height. Lipoatrophy on the other hand is loss of fat, particularly on the cheek, face, shoulder and limbs. We herewith report a 51 y...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Malaysian Endocrine and Metabolic Society
2014
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/49080/6/PP-046.pdf http://irep.iium.edu.my/49080/ http://www.jmems.org/index.php/jmems/issue/view/5 |
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| Summary: | Introduction: Patient with lipodystrophy is usually underweight, with a
body mass index (BMI) of under 18.5 or a weight 15% to 20% below that
of normal for age and height. Lipoatrophy on the other hand is loss of fat,
particularly on the cheek, face, shoulder and limbs.
We herewith report a 51 year old lady with a clinical diagnosis of
lipodystrophy. She has been underweight since her late 20’s. Her weight
was 25 kg, height 155 cm and BMI 11kg/m2. She was otherwise healthy
with no other systemic symptoms to suggest gastrointestinal, connective
tissue, neurology or endocrine disorders. Clinical examination revealed a
very thin and cachectic lady with generalised loss of fat, especially in the
cheeks, temples, neck, shoulder, trunk, upper limbs and lower limbs. There
was no acanthosis nigricans. She has no metabolic complications such as
insulin resistance, cardiovascular disease,
She has normochromic normocytic anaemia with a haemoglobin of 9.5
g/dl. Other investigations such as renal, liver, lipid, thyroid function test,
albumin and creatinine kinase levels were normal. Connective tissue
screening including C3, C4, rheumatoid factor and antinuclear antibody
were negative.
In 2004, she developed avascular necrosis of the left hip secondary to
prolonged steroid use which was started in 1994 to improve her weight.
She had osteoporosis with serial DEXA scan showing worsening of bone
mineral density (BMD). Whole body DEXA scan was recently performed to
assess her body fat distribution as she had refused any tissue biopsy. Her
percentage of total body fat was 21.2% (25872g) which was adequate,
hence excluded the diagnosis of lipodystrophy as a cause for being
underweight. Her android/gynoid ratio was 0.79.
Short of doing elaborate extensive investigations to diagnose lipodystrophy,
we have resorted to the use of DEXA to confirm the presence of adipose
tissue in this patient, thus excluding the diagnosis. As for her current
treatment, she has been started on hormone replacement therapy to treat
her osteoporosis. |
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