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:	WS, Wan Juani, M, Azura Dina, Sukor, Norlela, Mustafa, Norlaila, AW, Norasyikin, Omar, Ahmad Marzuki, R, Subashini, Loh, Huai Heng, Shahar, Mohammad Arif, O, Mohd Rahman, Kamaruddin, Nor Azmi
Format:	Article
Language:	English
Published:	Malaysian Endocrine and Metabolic Society 2014
Subjects:	RC Internal medicine
Online Access:	http://irep.iium.edu.my/49080/ http://irep.iium.edu.my/49080/ http://irep.iium.edu.my/49080/6/PP-046.pdf

id	iium-49080
recordtype	eprints
spelling	iium-490802018-06-19T08:09:11Z http://irep.iium.edu.my/49080/ Underweight and lipodystrophy…a medical conundrum WS, Wan Juani M, Azura Dina Sukor, Norlela Mustafa, Norlaila AW, Norasyikin Omar, Ahmad Marzuki R, Subashini Loh, Huai Heng Shahar, Mohammad Arif O, Mohd Rahman Kamaruddin, Nor Azmi RC Internal medicine 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. Malaysian Endocrine and Metabolic Society 2014-05 Article PeerReviewed application/pdf en http://irep.iium.edu.my/49080/6/PP-046.pdf WS, Wan Juani and M, Azura Dina and Sukor, Norlela and Mustafa, Norlaila and AW, Norasyikin and Omar, Ahmad Marzuki and R, Subashini and Loh, Huai Heng and Shahar, Mohammad Arif and O, Mohd Rahman and Kamaruddin, Nor Azmi (2014) Underweight and lipodystrophy…a medical conundrum. Journal of Endocrinology and Metabolism, 4 (1(Sup)). p. 30. ISSN 2229-9572 http://www.jmems.org/index.php/jmems/issue/view/5
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RC Internal medicine
spellingShingle	RC Internal medicine WS, Wan Juani M, Azura Dina Sukor, Norlela Mustafa, Norlaila AW, Norasyikin Omar, Ahmad Marzuki R, Subashini Loh, Huai Heng Shahar, Mohammad Arif O, Mohd Rahman Kamaruddin, Nor Azmi Underweight and lipodystrophy…a medical conundrum
description	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.
format	Article
author	WS, Wan Juani M, Azura Dina Sukor, Norlela Mustafa, Norlaila AW, Norasyikin Omar, Ahmad Marzuki R, Subashini Loh, Huai Heng Shahar, Mohammad Arif O, Mohd Rahman Kamaruddin, Nor Azmi
author_facet	WS, Wan Juani M, Azura Dina Sukor, Norlela Mustafa, Norlaila AW, Norasyikin Omar, Ahmad Marzuki R, Subashini Loh, Huai Heng Shahar, Mohammad Arif O, Mohd Rahman Kamaruddin, Nor Azmi
author_sort	WS, Wan Juani
title	Underweight and lipodystrophy…a medical conundrum
title_short	Underweight and lipodystrophy…a medical conundrum
title_full	Underweight and lipodystrophy…a medical conundrum
title_fullStr	Underweight and lipodystrophy…a medical conundrum
title_full_unstemmed	Underweight and lipodystrophy…a medical conundrum
title_sort	underweight and lipodystrophy…a medical conundrum
publisher	Malaysian Endocrine and Metabolic Society
publishDate	2014
url	http://irep.iium.edu.my/49080/ http://irep.iium.edu.my/49080/ http://irep.iium.edu.my/49080/6/PP-046.pdf
first_indexed	2023-09-18T21:09:26Z
last_indexed	2023-09-18T21:09:26Z
_version_	1777411153449713664

Underweight and lipodystrophy…a medical conundrum

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