Background Berardinelli–Seip congenital lipodystrophy (BSCL) is a rare disease, with an estimated prevalence of 1 in 10 million worldwide and 1:500 000 cases in Portugal ( 1 ). It is characterized by the absence of subcutaneous adipose tissue
Carolina Chaves, Mariana Chaves, João Anselmo, and Rui César
Fiona Melzer, Corinna Geisler, Dominik M Schulte, and Matthias Laudes
Background Lipodystrophy (LD) syndromes are rare heterogeneous disorders with diverse pathophysiology characterized by selective deficiency (partial LD) or complete (total LD) loss of adipose tissue with ectopic lipid accumulation, for example
P Hanson, M Pandit, V Menon, S Roberts, and T M Barber
aetiology of fat necrosis is thought to result from local trauma and tissue injury caused by both physical and chemical insults, stimulating an inflammatory reaction within the adipose tissue (3) . Aseptic saponification of fat by lipases was proposed to be
Athanasios Fountas, Zoe Giotaki, Evangelia Dounousi, George Liapis, Alexandra Bargiota, Agathocles Tsatsoulis, and Stelios Tigas
Background Lipodystrophy is a rare group of clinically heterogeneous disorders characterized by the complete or partial loss of subcutaneous adipose tissue ( 1 , 2 ). This condition is often accompanied by metabolic complications such as
Priya Darshani Chhiba and David Segal
spontaneously over time by avoiding the injection area, which also occurred in our index case. Discussion Lipodystrophy is a disorder of adipose tissue, presenting either as lipohypertrophy or lipoatrophy ( 5 ). Lipoatrophy is defined as a large, often
Ulla Kampmann, Per Glud Ovesen, Niels Møller, and Jens Fuglsang
. Hyperleptinemia is a result of an increased synthesis and secretion from abundant adipose tissue ( 6 ), but leptin is also secreted in the placenta and leptin levels increase substantially during pregnancy. McIntyre et al. conclude that maternal insulin
Aysenur Ozderya, Sule Temizkan, Kadriye Aydin Tezcan, Feyza Yener Ozturk, and Yuksel Altuntas
supraclavicular area ( Fig. 2 ). Biopsies from these areas were concordant with lipomatous tissue ( Fig. 3 ). An abdominal CT examination revealed an enlarged liver (cranio-caudal axis: 24 cm) and spleen. After a differential diagnosis of the causes of the
Baris Akinci, Rasimcan Meral, Diana Rus, Rita Hench, Adam H Neidert, Frank DiPaola, Maria Westerhoff, Simeon I Taylor, and Elif A Oral
Background Lipodystrophy syndromes are a heterogeneous cluster of diseases characterized by loss of subcutaneous adipose tissue that leads to severe insulin resistance and dyslipidemia. Metreleptin therapy is now an approved treatment for
Deeb Daoud Naccache
Ten years after the successful withdrawal from heroin abuse, a person with diabetes suffered intractable pain and severe muscular emaciation consistent with the syndrome of diabetic neuropathic cachexia. Anti-neuropathic medications failed neither to alleviate suffering and reverse weight loss, nor to stop muscular emaciation. Vigilant evaluation for weight loss aetiologies revealed no responsible aetiology. Prescribing medical cannabis became mandatory, with the intention to alleviate neuropathic pain, regain muscular mass and strengthen legs, enable standing upright and walking normally. Medical cannabis for pain-relief, and the orexigenic properties of tetrahydrocannabinol (THC) ingredient successfully achieved these goals.
Medical cannabis can serve to promptly alleviate severe diabetic neuropathic pain.
Past history of heroin abuse was not an absolute contraindication to medical cannabis use.
Medical cannabis increased appetite and reversed muscular emaciation.
Medical cannabis decreased chronic pain and hence, its catabolic consequences.
Punith Kempegowda, Wentin Chen, Eka Melson, Annabelle Leong, Prashant Amrelia, and Ateeq Syed
A 37-year-old female of South Asian origin was referred to our diabetes clinic for evaluation of an unusual finding during her retinal screening. Her retinal blood vessels appeared white in contrast to the normal pink-red colour. She had type I hyperlipidaemia, confirmed by genotype, and was recently diagnosed with diabetes, secondary to pancreatic insufficiency, for which she had suboptimal control and multiple hospitalisations with recurrent pancreatitis. On examination, she had multiple naevi on her skin; the rest of the examination was unremarkable. The patient did not report any visual disturbances and had intact visual acuity. Investigations showed raised total cholesterol (12.5 mmol/L) and triglycerides (57.7 mmol/L). Following evaluation, the patient was diagnosed with lipaemia retinalis, secondary to type I hyperlipidaemia. The patient was managed conservatively to reduce the cholesterol and triglyceride burdens. However, therapies with orlistat, statin, fibrates and cholestyramine failed. Only a prudent diet, omega-3 fish oil, medium-chain triglycerides oil and glycaemic control optimised with insulin showed some improvements in her lipid profile. Unfortunately, this led her to becoming fat-soluble vitamin deficient; hence, she was treated with appropriate supplementation. She was also recently started on treatment with volanesorsen. Following this, her lipid parameters improved and lipaemia retinalis resolved.
Lipaemia retinalis is an uncommon incidental finding of type I hyperlipidaemia that may not affect vision.
Management of associated dyslipidaemia is challenging with minimal response to conventional treatment.
Increased awareness of lipaemia retinalis and specialist management is needed as part of regular patient monitoring and personalised management.