Lipodystrophy ( fatty degeneration ) is a pathological condition , often characterized by pathology of adipose tissue . There are two main types of lipodystrophy: atrophy and hypertrophy. With lipoatrophy, the creation of adipose tissue is impossible in a subject even in the absence of physical activity, gymnastics, and abundant consumption of fatty foods (butter or cream cakes, fatty meat, foods high in cholesterol, meals with oils, etc.) or foods that provoke the creation of subcutaneous fat (beer, some types of alcohol, carbonated drinks, etc.). The main difference between lipodystrophy and dystrophy is that the subject does not suffer from muscle thinness and other features characteristic of dystrophics, only adipose tissue is absent, while the muscle mass remains normal or even increases, which optimally affects the physique.
| Lipodystrophy | |
|---|---|
| ICD-10 | E 88.1 |
| ICD-10-KM | |
| ICD-9 | 272.6 |
| ICD-9-KM | |
| Diseasesdb | 30066 |
| eMedicine | med / 1307 med / 3523 |
| Mesh | D008060 |
Content
Classification
Distinguish [3] :
- Congenital lipodystrophy:
- Beradinelli-Seip Syndrome;
- Family partial lipodystrophy.
- Acquired lipodystrophy:
- Barraquer-Simons Syndrome (acquired partial lipodystrophy);
- Acquired generalized lipodystrophy;
- (Lipodystrophia centrifugalis abdominalis infantilis);
- Lipoatrophia annularis (Ferreira-Marques lipoatrophy);
- Insulin lipodystrophy;
- HIV-associated lipodystrophies;
- Other localized lipodystrophies.
Insulin Lipodystrophy
Lipodystrophy - areas of atrophy or hypertrophy of the subcutaneous fat layer at the injection site of insulin . Lipodystrophy can occur in a child from a few weeks to 8-10 years from the start of insulin therapy [4] . Insulin lipodystrophy is observed in 10-24% of patients, mainly in women and children receiving insulin therapy [Galloway JA, De Shazo RD, 1983] regardless of the dose and type of hormone administered , the severity of diabetes mellitus and the state of its compensation [5] . This complication of insulin therapy manifests itself in the form of:
- atrophy (atrophic form) - partial or complete disappearance of the subcutaneous base, sometimes outside the injection zone (repercussion lipodystrophy), is associated with insufficient purification of insulin preparations ;
- hypertrophy (hypertrophic form) - at the injection sites of insulin, seals and infiltrates of the skin and subcutaneous base are formed, associated with the lipogenic effect of the hormone .
Lipoatrophy causes a cosmetic defect that adversely affects the mental status of patients (especially women, in whom they are observed more often), as a rule, occurs at insulin injection sites. However, pronounced lipoatrophy can be observed in various parts of the body, even where insulin has never been administered [6] . Clinically characterized by a complete lack of subcutaneous fat around the injection site of insulin. Violation of vascularization at the site of lipoatrophy worsens the processes of insulin absorption, preventing the achievement of a stable compensation of diabetes mellitus - it is practically impossible to correctly calculate the start and end time of the administered insulin preparations, especially the prolonged action [6] . The pathogenesis of the development of lipoatrophy is still not entirely clear. It is known that the development of lipoatrophy contributes to the acidic pH of insulin preparations, a violation of the injection technique (alcohol entering the skin at the time of injection, low temperature of the injected solution). Most researchers adhere to the point of view that the emergence of lipoatrophy is based on immune mechanisms [6] .
Hypertrophic lipodystrophies - an increase in subcutaneous fat at the injection site of insulin. Histological examination of the biopsy material of the lipohypertrophy site reveals proliferation of fibrous tissue and a sharp decrease in vascularization of the affected area of the skin. These changes significantly impair the absorption of insulin from the affected areas, preventing the achievement of stable compensation for diabetes mellitus [6] .
The appearance of lipodystrophies, as a rule, worsens the course of the disease (at the injection sites, insulin absorption is impaired, which leads to insulin resistance ). The introduction into clinical practice of highly purified types of insulin (monopic and monocomponent), as well as human insulin preparations, lipodystrophy, as well as other side effects of insulin therapy, are less common [5] .
HIV antiretroviral therapy
The development of lipodystrophy is a possible side effect of the use of antiretroviral drugs for the treatment of HIV infection. Lipodystrophy is manifested by redistribution of subcutaneous fat lipids with excess (hypertrophy) or lack of fat in various areas of the body. They can be combined with hollow cheeks and / or humps on the back or neck (the so-called "buffalo hump") [7] .
Hereditary forms of lipodystrophy
The development of lipodystrophy can be caused by metabolic disorders against the background of the realization of a genetic predisposition. They are often characterized by insulin resistance and are combined with the development of metabolic syndrome .
Veterinary Lipodystrophy
Impaired lipid metabolism can be cellular, or parenchymal (impaired metabolism of cytoplasmic fat), extracellular, or stromal-vascular (impaired metabolism of fat in adipose tissue), and mixed (systemic lipoids, etc.). The development mechanism distinguishes: infiltration, transformation, decomposition, that is, the breakdown of cellular protein-lipid complexes, membranes and macromolecules, and altered synthesis. This changes not only the quantitative content of fat, but also its qualitative composition with the advent of fat decay products. [eight]
See also
- Changes in organs and systems in diabetes
- Metabolic syndrome
- HIV infection
- Metreleptin
Notes
- ↑ Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
- ↑ Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
- ↑ James, William D .; Berger, Timothy G. .; et al. Andrews' Diseases of the Skin: clinical Dermatology. - Saunders Elsevier, 2006. - ISBN 0-7216-2921-0 .
- ↑ Handbook of Pediatric Endocrinologist / Ed. M.A. Zhukovsky. - 1st ed. - M .: Medicine, 1992 .-- S. 137-138. - 304 p. - 20,000 copies. - ISBN 5-225-02616-8 .
- ↑ 1 2 Clinical Diabetology / Efimov A.S., Skrobonskaya N.A. - 1st ed. - Kiev: Health, 1998. - P. 85-94. - 320 p. - 3000 copies. - ISBN 5-311-00917-9 .
- ↑ 1 2 3 4 Kasatkina E.P. Diabetes mellitus in children. - 1st ed. - M .: Medicine, 1990. - S. 163-167 and 207. - 272 p. - 60,000 copies. - ISBN 5-225-01165-9 .
- ↑ Physical and Biochemical Changes in HIV Disease Eric S. Daar, MD MedicineNet, Accessed September 22, 2007
- ↑ A.V. Zharov, V.P. Shishkov et al. Pathological anatomy of farm animals. - M .: Kolos, 1995 .-- 543 p.