eMedicine Specialties > Endocrinology > Metabolic Disorders

Lipodystrophy, Localized: Differential Diagnoses & Workup

Author: Serhat Aytug, MD, Staff Physician, Division of Endocrinology, Diabetes and Metabolism, CrystalRun Healthcare
Coauthor(s): Rubens Sievert, MD, Clinical Assistant Professor, Department of Internal Medicine, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Oct 29, 2009

Differential Diagnoses

Lipodystrophy, Acquired Partial

Other Problems to Be Considered

Congenital partial lipodystrophy
Congenital generalized lipodystrophy
Acquired partial lipodystrophy
Acquired generalized lipodystrophy
Lipodystrophy secondary to protease inhibitor usage in patients infected with HIV
Progressive lipodystrophy
Lipodystrophia progressiva
Barraquer Simons disease (progressive lipodystrophy)
Lipodystrophia facialis
Cephalothoracic brachial form of lipodystrophy
Progressive cephalothoracic lipodystrophy
Lipoatrophic diabetes

Workup

Laboratory Studies

  • No specific laboratory blood tests exist to diagnose lipodystrophy.
  • Serological markers of systemic connective tissue diseases can be present with the inflammatory type of lipodystrophies.

Imaging Studies

No specific imaging study to diagnose localized lipodystrophy exists.

Other Tests

Histopathological examination is the hallmark of diagnosis.

Procedures

Obtaining a biopsy of lesions is the diagnostic procedure of choice, and performing a histopathological examination might be helpful to diagnose and guide the treatment.

Histologic Findings

Histology depends on the type of lipodystrophy. According to one study, 2 main histopathological subsets exist.7 One form, termed involutional fat, is a distinctive picture characterized by lobules of small lipocytes embedded in hyaline connective tissue, peripheral lobular accentuation, absence or scarcity of inflammatory cells, and myxoid stroma with numerous capillaries. Most of the patients with this type of histology have a single lesion, usually of the upper arm. Results of serological studies are normal. Of 3 cases in which direct immunofluorescence was performed, only one patient showed immunoreactants in the blood vessels.

The other type of histology is more of an inflammatory type, with inflammation of the fat. Normal-appearing lipocytes and normal vasculature are present, as well as scattered focal lymphocytes, histiocytes, and plasma cells. This histology involves multiple areas of localized lipoatrophy. In the early biopsy specimens of a series of 4 patients, lymphocytic panniculitis was observed, emphasizing the inflammatory basis for this disorder.8

Staging

Classification of partial or localized lipodystrophy involves association with the following:

  • Nephritis with low complement levels (membranoproliferative glomerulonephritis)
  • Scleroderma
  • Sjögren syndrome
  • Systemic lupus erythematosus
  • Recurrent pyogenic infections
  • Thyroiditis secondary to intradermal or subcutaneous injections
  • Injection of insulin, corticosteroids, and other medications (eg, IM penicillin G, iron dextrans, diphtheria/pertussis/tetanus vaccine, acupuncture, recombinant growth hormone injections)
  • Lipoatrophy secondary to panniculitis of connective tissue disease
  • Lupus panniculitis/profundus
  • Lymphocytic connective tissue panniculitis
  • Localized lipoatrophy
  • Annular lipoatrophy
  • Abdominal lipoatrophy
  • Atrophic panniculitis

More on Lipodystrophy, Localized

Overview: Lipodystrophy, Localized
Differential Diagnoses & Workup: Lipodystrophy, Localized
Treatment & Medication: Lipodystrophy, Localized
Follow-up: Lipodystrophy, Localized
References
Further Reading
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References

  1. Touraine P, D'Souza GA, Kourides I, et al. Lipoatrophy in GH deficient patients treated with a long-acting pegylated GH. Eur J Endocrinol. Oct 2009;161(4):533-40. [Medline].

  2. Winkelmann RK, Padilha-Goncalves A. Connective tissue panniculitis. Arch Dermatol. Mar 1980;116(3):291-4. [Medline].

  3. Gdynia HJ, Weydt P, Ernst A, et al. Myositis associated with localized lipodystrophy: an unrecognized condition?. Eur J Med Res. May 14 2009;14(5):228-30. [Medline].

  4. Hisamichi K, Suga Y, Hashimoto Y, Matsuba S, Mizoguchi M, Ogawa H. Two Japanese cases of localized involutional lipoatrophy. Int J Dermatol. Mar 2002;41(3):176-7. [Medline].

  5. Yamamoto T, Yokozeki H, Nishioka K. Localized involutional lipoatrophy: report of six cases. J Dermatol. Oct 2002;29(10):638-43. [Medline].

  6. Soos N, Shakery K, Mrowietz U. Localized panniculitis and subsequent lipoatrophy with subcutaneous glatiramer acetate (Copaxone) injection for the treatment of multiple sclerosis. Am J Clin Dermatol. 2004;5(5):357-9. [Medline].

  7. Winkelmann RK, Frigas E. Eosinophilic panniculitis: a clinicopathologic study. J Cutan Pathol. Feb 1986;13(1):1-12. [Medline].

  8. Winkelmann RK. [Panniculitis with cellular phagocytosis. Chronic form of histiocytic panniculitis with fever, pancytopenia, polyserositis and lethal hemorrhagic diathesis]. Hautarzt. Nov 1980;31(11):588-94. [Medline].

  9. Gassling VL, Douglas T, Wiltfang J, et al. Unilateral atrophy of the cheek: autologous fat injection as treatment of choice. J Craniofac Surg. Mar 2009;20(2):423-5. [Medline].

  10. Buyukgebiz A, Aydin A, Dundar B, Yorukoglu K. Localized lipoatrophy due to recombinant growth hormone therapy in a child with 6.7 kilobase gene deletion isolated growth hormone deficiency. J Pediatr Endocrinol Metab. Jan-Feb 1999;12(1):95-7. [Medline].

  11. Capanni C, Mattioli E, Columbaro M, Lucarelli E, Parnaik VK, Novelli G, et al. Altered pre-lamin A processing is a common mechanism leading to lipodystrophy. Hum Mol Genet. Jun 1 2005;14(11):1489-502. [Medline].

  12. Drago F, Rongioletti F, Battifoglio ML, Rebora A. Localised lipoatrophy after acupuncture. Lancet. May 25 1996;347(9013):1484. [Medline].

  13. Koshy CE, Evans J. Facial contour reconstruction in localised lipodystrophy using free radial forearm adipofascial flaps. Br J Plast Surg. Oct 1998;51(7):499-502. [Medline].

  14. Peters MS, Winkelmann RK. Localized lipoatrophy (atrophic connective tissue disease panniculitis). Arch Dermatol. Dec 1980;116(12):1363-8. [Medline].

  15. Peters MS, Winkelmann RK. The histopathology of localized lipoatrophy. Br J Dermatol. Jan 1986;114(1):27-36. [Medline].

  16. Serrao VV, Feio AB. Localized abdominal idiopathic lipodystrophy. Dermatol Online J. Jul 15 2008;14(7):15. [Medline].

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Keywords

localized lipodystrophy, lipodystrophy, lipoatrophy, adipose tissue, atrophic lesions, tissue atrophy, lipoatrophic, fat lesions, fat lesion

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Contributor Information and Disclosures

Author

Serhat Aytug, MD, Staff Physician, Division of Endocrinology, Diabetes and Metabolism, CrystalRun Healthcare
Serhat Aytug, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, Endocrine Society, and Pituitary Society
Disclosure: Nothing to disclose.

Coauthor(s)

Rubens Sievert, MD, Clinical Assistant Professor, Department of Internal Medicine, Mount Sinai School of Medicine
Rubens Sievert, MD is a member of the following medical societies: American Thyroid Association
Disclosure: Nothing to disclose.

Medical Editor

David M Klachko, MBBCh, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri
David M Klachko, MBBCh is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Endocrine Society, Missouri State Medical Association, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS, Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, American Society of Law Medicine and Ethics, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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