Diabetes with partial lipodystrophy following sclerodermatous chronic graft vs. host disease.
BACKGROUND
The importance of adipose tissue in metabolism, as a target for insulin action and a secretor of metabolic regulatory proteins, is increasingly recognized. Lipodystrophic conditions are often associated with significant insulin resistance. The commonest acquired form occurs with highly active antiretroviral therapy (HAART) for human immunodeficiency virus infection. Other medical conditions and drugs also have the potential to cause chronic subcutaneous fat damage.


METHODS
We describe an unfamiliar partial lipodystrophy in a young woman, associated with markedly insulin-resistant diabetes, acquired following allogeneic bone marrow transplantation for childhood leukaemia complicated by late sclerodermatous chronic graft vs. host disease (GVHD). Clinical examination revealed scarring and lipodystrophy affecting mainly legs, thighs, buttocks and forearms but sparing her face, neck and thorax. Her serum adiponectin level was markedly reduced.


CONCLUSIONS
However, although thiazolidinediones lower insulin resistance and increase subcutaneous peripheral fat in Type 2 diabetes, pioglitazone treatment had little effect on either serum adiponectin, glycaemic control or the lipoatrophy. In this case, effective glycaemic control was best achieved using a combination of metformin and highly concentrated soluble insulin injections.
Rooney
D P
DP
Department of Diabetes and Endocrinology and Biochemistry Laboratory, Antrim Area Hospital, Antrim, UK. dprooney@doctors.org.uk
Ryan
M F
MF
D000293:Adolescent; D016026:Bone Marrow Transplantation; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008060:Lipodystrophy / Q000209:etiology*; D008687:Metformin / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D012594:Scleroderma, Localized / Q000188:drug therapy / Q000209:etiology*; D014184:Transplantation, Homologous
D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin