Acquired Lipodystrophy: Causes, Symptoms, Diagnosis & Treatment

Acquired Lipodystrophy: Causes, Symptoms, Diagnosis & Treatment

Acquired Generalized & Partial Lipodystrophy: Types, Causes, and Modern Treatments

Learn about Acquired Lipodystrophy, including AGL and APL, symptoms, diagnosis, causes, hormonal imbalance, complications, and the latest treatment options such as metreleptin therapy.

Acquired lipodystrophy is a rare metabolic disorder in which the body progressively loses subcutaneous fat. Unlike congenital forms, acquired lipodystrophy develops later in life due to infections, autoimmune conditions, drug exposure, or unknown factors. The loss of fat can be generalized (affecting the whole body) or partial (affecting specific regions). As fat is lost, the body may begin storing fat in inappropriate organs such as the liver, heart, and skeletal muscle, leading to metabolic complications.

A key feature of acquired lipodystrophy is reduced levels of leptin and adiponectin, hormones produced by fat cells. Low leptin levels contribute to severe hunger, insulin resistance, diabetes, and high triglycerides.

Types of Acquired Lipodystrophy

Causes

While not always known, triggers include:

• Autoimmune disorders (e.g., rheumatoid arthritis, thyroiditis, dermatomyositis)
• Viral or bacterial infections such as measles, hepatitis, varicella, or infectious mononucleosis
• Medications used in HIV treatment (notably older protease inhibitors)
• Repeated injections or trauma to the same area (localized form)

Research suggests immune-mediated destruction of adipocytes and complement activation plays a major role, especially in APL.

Symptoms

Symptoms vary depending on the type and severity:

• Visible loss of fat in the face, arms, legs, palms, and feet (AGL)
• Increased appetite and rapid growth in children
• Muscular or vein-prominent appearance
• Acanthosis nigricans (dark patches in body folds)
• Irregular menstrual cycles or PCOS-like features in females
• Enlarged liver or spleen
• High triglycerides, high cholesterol, insulin resistance, or diabetes

Complications

If untreated, acquired lipodystrophy can lead to:

• Severe insulin-resistant diabetes
• Fatty liver disease and cirrhosis
• Pancreatitis from high triglycerides
• Cardiovascular disease
• Co-existing autoimmune conditions

Diagnosis

Diagnosis involves:

• Physical examination and fat distribution assessment
• Lipid profile, fasting glucose, HbA1c
• Leptin and adiponectin levels
• Complement C3 levels (often low in APL)
• Liver ultrasound or MRI to evaluate fatty liver
• Genetic tests to exclude congenital forms

Treatment 

There is no cure, but treatment focuses on metabolic control and hormone replacement when necessary.

1] Metreleptin (Myalept) Therapy

• FDA-approved for leptin-deficient generalized lipodystrophy
• Helps reduce hunger, improve insulin resistance, lower triglycerides, and control blood sugar
• Long-term therapy proven to reduce liver fat and metabolic complications

2] Dietary and Lifestyle Management

• Low-fat, balanced diet
• Avoid sugary beverages and refined carbs
• Regular cardiovascular and strength training exercise to improve insulin sensitivity

3] Medications

Important Note

Women with AGL should avoid oral estrogen as it may worsen triglyceride levels.

Living with Acquired Lipodystrophy

• Emotional support and counseling are important due to changes in appearance.
• Encourage social confidence and self-esteem.
• Many people live active, healthy lives when metabolic risks are controlled.

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