1
|
Guo L, Li W, Xu X, Xiao H. Madelung disease with postoperative priapism and multiple venous thromboses: case report and literature review. Front Cardiovasc Med 2024; 11:1449556. [PMID: 39257843 PMCID: PMC11383766 DOI: 10.3389/fcvm.2024.1449556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
Madelung disease is an uncommon metabolic disorder of uncertain pathogenesis, distinguished by the symmetric accumulation of nonencapsulated adipose tissue within the subcutaneous layer of the neck, abdomen, thighs, and other anatomical regions. This condition has been tightly connected with comorbidities including diabetes, dyslipidemia, hyperuricemia, hypothyroidism, and adrenal dysfunction, as well as sensory, motor, and autonomic polyneuropathy. The prevalence of Madelung disease is conspicuously higher in Mediterranean and Eastern European, with a distinct scarcity within the Asian population. Surgical interventions involving lipectomy and liposuction represent the foremost and most efficacious treatment approach. Herein, we present a case encompassing type II Madelung disease featuring bilateral thighs adipose tissue accumulation. The patient exhibited unexplained priapism alongside multiple venous thrombosis during four surgical interventions. The infrequent manifestation of postoperative hypercoagulability in patients of Madelung disease merits broad attention, owing to the potentiality for extensive venous thrombosis and consequential severe outcomes such as pulmonary embolism or cerebral infarction arising from thrombus dislodgment. Building upon this clinical scenario, we systematically documented the clinical manifestations and disease progression in this patient, meticulously analyzed the causes of complications, and proposed targeted preventive measures. Additionally, we conducted a comprehensive review of the relevant literature to summarize the clinical and epidemiological features of Madelung disease and to elucidate its mechanisms. This study will provide a valuable reference for future clinical treatments and mitigate perioperative complications of Madelung disease.
Collapse
Affiliation(s)
- Linfen Guo
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Li
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuewen Xu
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haitao Xiao
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Şükün A, Demirci MF, Akbay E. Type 1C Multiple Symmetrical Lipomatosis: A Cause of Misdiagnosis in Females. Cureus 2023; 15:e40970. [PMID: 37503462 PMCID: PMC10370365 DOI: 10.7759/cureus.40970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
Multiple symmetrical lipomatosis (MSL) is a disease that causes symmetrical fat deposits in the neck, shoulders, and upper trunk. It is more common in the neck area in men who consume alcohol. The male-to-female ratio varies from 15:1 to 30:1. Madelung's disease has been reported in a small number of female patients who do not consume alcohol. Pseudoathletic appearance (MSL type 1C) is rare and causes misdiagnosis. We would like to present a 50-year-old woman with an athletic appearance who had fat deposits on her shoulders and upper chest. After excluding obesity and Cushing's syndrome, which were initially considered, we aimed to remind people of this entity that causes symmetrical fat deposits in the upper trunk in females.
Collapse
Affiliation(s)
- Abdullah Şükün
- Department of Radiology, Başkent University Alanya Research and Application Center, Antalya, TUR
| | - Mehmet Fatih Demirci
- Department of Internal Medicine, Başkent University Alanya Research and Application Center, Antalya, TUR
| | - Ertan Akbay
- Department of Cardiology, Başkent University Alanya Research and Application Center, Antalya, TUR
| |
Collapse
|
3
|
Li S, Xiao Y, Wang Y, Bai M, Du F, Zhang H. Exploration of Influencing Factors for Postoperative Recurrence in Patients with Madelung's Disease on the Basis of Multivariate Stepwise Cox Regression Analysis. Clin Cosmet Investig Dermatol 2023; 16:103-110. [PMID: 36686607 PMCID: PMC9851055 DOI: 10.2147/ccid.s368273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/16/2022] [Indexed: 01/16/2023]
Abstract
Purpose Madelung's disease (MD) is a rare condition of massive deposits of fat accumulations between superficial and deep fascia at typical locations. There is an absence of systematic studies related to MD in the Chinese cohort. Thus, the objective of the study was to investigate the clinical features of the MD cases in our institution and to explore the clinical variables associated with postoperative recurrence. Materials and Methods We retrospectively analyzed the clinical information of 21 individuals with MD from 2013 to 2021 enrolled in our institution. The paired t-test and χ 2 test were, respectively, used to determine the difference between continuous and classified variables. The univariate Kaplan-Meier analysis by log-rank and multivariate stepwise Cox regression analysis were used to explore variables possibly associated with postoperative recurrence in MD individuals. Results In the current study, 90.48% of the studied patients were male with a mean age of 48.76 years old. About 61.90% exhibited type I MD. MD patients who experienced postoperative recurrence had a higher age, BMI, incidence of chronic complications, and prevalence of alcoholism than the other MD patients without recurrence (P < 0.05). The univariate Kaplan-Meier analysis by log-rank identified that age, BMI, alcoholism, and comorbidities were influencing factors related with postoperative recurrence (P < 0.05). Conclusion Demographic characteristics of the 21 studied Chinese cases with MD were generally in accordance with previously published data of other foreign populations. The factors possibly influencing the postoperative recurrence for patients with MD were age, BMI, alcoholism, and a combination of comorbidities. This is the first time that a summarization of clinical characteristics and postoperative recurrence variables of Chinese patients with MD has been reported.
Collapse
Affiliation(s)
- Shuo Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yiding Xiao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yang Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ming Bai
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Fengzhou Du
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Hailin Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| |
Collapse
|
4
|
Lopriore P, Ricciarini V, Siciliano G, Mancuso M, Montano V. Mitochondrial Ataxias: Molecular Classification and Clinical Heterogeneity. Neurol Int 2022; 14:337-356. [PMID: 35466209 PMCID: PMC9036286 DOI: 10.3390/neurolint14020028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 01/25/2023] Open
Abstract
Ataxia is increasingly being recognized as a cardinal manifestation in primary mitochondrial diseases (PMDs) in both paediatric and adult patients. It can be caused by disruption of cerebellar nuclei or fibres, its connection with the brainstem, or spinal and peripheral lesions leading to proprioceptive loss. Despite mitochondrial ataxias having no specific defining features, they should be included in hereditary ataxias differential diagnosis, given the high prevalence of PMDs. This review focuses on the clinical and neuropathological features and genetic background of PMDs in which ataxia is a prominent manifestation.
Collapse
|
5
|
Wanke J, Yongjing F. A case report of Madelung's disease in China. Radiol Case Rep 2021; 17:320-325. [PMID: 34876958 PMCID: PMC8633830 DOI: 10.1016/j.radcr.2021.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022] Open
Abstract
Madelung disease (MD) is a rare form of lipodystrophy, which refers to diffuse and symmetrical adipose tissue deposition in the superficial and deep subcutaneous fascial spaces, presenting as multiple painless masses throughout the body. The disease is most commonly seen in middle-aged men who have been drinking alcohol for a long time and has not been reported domestically. This article analyzed the clinical data with Madelung's disease, discussed its etiology, clinical manifestations, diagnosis, and treatment methods, and provided help for clinical diagnosis and treatment.
Collapse
Affiliation(s)
- Jin Wanke
- School of Medicine, Nanchang University, No. 1299, Xuefu Avenue, Honggutan New District, Nanchang City, Jiangxi Province, China, 330031
| | - Fan Yongjing
- Department of Stomatology, The Affiliated Hospital of Inner Mongolia Medical University , Hohhot, Inner Mongolia, China, 010010.,Mongolian National University of Medical Sciences, Mongolia
| |
Collapse
|
6
|
Wu L, Jiang T, Zhang Y, Tang AQ, Wu LH, Liu Y, Li MQ, Zhao LB. Madelung's disease with alcoholic liver disease and acute kidney injury: A case report. World J Clin Cases 2021; 9:8199-8206. [PMID: 34621881 PMCID: PMC8462200 DOI: 10.12998/wjcc.v9.i27.8199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/17/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Madelung's disease (MD) is a rare disorder of lipid metabolism, characterized by the growth of unencapsulated masses of adipose tissue symmetrically deposited around the neck, shoulders, or other sites around the body. Its pathological mechanism is not yet known. One of the most common comorbidities in MD patients is liver disease, especially chronic alcoholic liver disease (CALD); however, no reports exist of acute kidney injury (AKI) with MD. CASE SUMMARY We report a 60-year-old man who presented with complaint of edema in the lower limbs that had persisted for 3 d. Physical examination showed subcutaneous masses around the neck, and history-taking revealed the masses to have been present for 2 years and long-term heavy drinking. Considering the clinical symptoms, along with various laboratory test results and imaging characteristics, a diagnosis was made of MD with acute exacerbation of CALD and AKI. The patient was treated with liver function protection and traditional Chinese medicine, without surgical intervention. He was advised to quit drinking. After 10 d, the edema had subsided, renal function indicators returned to normal, liver function significantly improved, and size of subcutaneous masses remained stable. CONCLUSION In MD, concomitant liver or kidney complications are possible and monitoring of liver and kidney functions can be beneficial.
Collapse
Affiliation(s)
- Ling Wu
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Ting Jiang
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Yan Zhang
- Department of Ultrasound, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - An-Qi Tang
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Li-Hua Wu
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Yu Liu
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Ming-Quan Li
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Liang-Bin Zhao
- Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| |
Collapse
|
7
|
Soomro S, Ziahosseini K, Sharma P. Proptosis of the eye: a potential form of Madelung's disease. BMJ Case Rep 2021; 14:e243669. [PMID: 34511421 PMCID: PMC8438748 DOI: 10.1136/bcr-2021-243669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
Madelung's disease is a rare disorder characterised by excessive and symmetrical deposits of adipose tissue, typically in the cervicofacial region. Alcohol is a known cause of the condition, however, there are reports that this condition is genetically inherited. Lipomatosis of the orbit has been described in the alcoholic Madelung's disease, however, in our case report, we believe this is the first reported instance of proptosis caused by the genetic form of the condition. We present a 69-year-old woman, with a medical history of genetic Madelung's disease, who presented with bilateral proptosis worse in her right eye. Her ocular examination was normal apart from exophthalmometry, showing bilateral proptosis. This was confirmed by an MRI, which further showed intraorbital fat deposition bilaterally. Due to the stability of her condition, no treatment was deemed necessary. We highlight the importance of monitoring for progressive optic nerve compromise and liposarcomatous malignant transformation.
Collapse
Affiliation(s)
- Shayan Soomro
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kimia Ziahosseini
- Ophthalmology Department, Norfolk and Norwich University Hospitals Eye Department, Norwich, UK
| | - Poonam Sharma
- Ophthalmology Department, Norfolk and Norwich University Hospitals Eye Department, Norwich, UK
| |
Collapse
|
8
|
Brandão BB, Poojari A, Rabiee A. Thermogenic Fat: Development, Physiological Function, and Therapeutic Potential. Int J Mol Sci 2021; 22:5906. [PMID: 34072788 PMCID: PMC8198523 DOI: 10.3390/ijms22115906] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/30/2021] [Accepted: 05/27/2021] [Indexed: 12/11/2022] Open
Abstract
The concerning worldwide increase of obesity and chronic metabolic diseases, such as T2D, dyslipidemia, and cardiovascular disease, motivates further investigations into preventive and alternative therapeutic approaches. Over the past decade, there has been growing evidence that the formation and activation of thermogenic adipocytes (brown and beige) may serve as therapy to treat obesity and its associated diseases owing to its capacity to increase energy expenditure and to modulate circulating lipids and glucose levels. Thus, understanding the molecular mechanism of brown and beige adipocytes formation and activation will facilitate the development of strategies to combat metabolic disorders. Here, we provide a comprehensive overview of pathways and players involved in the development of brown and beige fat, as well as the role of thermogenic adipocytes in energy homeostasis and metabolism. Furthermore, we discuss the alterations in brown and beige adipose tissue function during obesity and explore the therapeutic potential of thermogenic activation to treat metabolic syndrome.
Collapse
Affiliation(s)
- Bruna B. Brandão
- Section of Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Ankita Poojari
- Department of Physiology & Pharmacology, Thomas J. Long School of Pharmacy & Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Atefeh Rabiee
- Department of Physiology & Pharmacology, Thomas J. Long School of Pharmacy & Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| |
Collapse
|
9
|
Jung K, Lee S. A case report of Multiple Symmetric Lipomatosis (MSL) in an East Asian Female. BMC Womens Health 2020; 20:200. [PMID: 32928192 PMCID: PMC7488652 DOI: 10.1186/s12905-020-01055-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/25/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Multiple Symmetric Lipomatosis (MSL) is a rare disorder related to fat metabolism and lipid storage. The condition results in characteristic depositions of fat, especially around the cephalic, cervical, and upper thoracic subcutaneous. It is much more common in adult males who live in the Mediterranean region and has only rarely been reported in Asian females. In this report, we present a case of an Asian female with MSL and also review the clinical features of the condition, including radiological and histological findings required for proper diagnosis and management. CASE PRESENTATION A 59-year-old Korean female came in with a chief complaint of palpable mass present in shoulder and upper back regions. Images showed diffuse non-encapsulated adipose tissue in the subcutaneous layer of the suboccipital, posterior neck area. The patient wanted to remove the mass for cosmetic reasons and discomfort. Excisional biopsy was planned. Preoperative blood analyses showed deteriorated liver function, and the computed tomography findings were consistent with liver cirrhosis. Detailed history taking revealed that she consumed highly levels of alcohol. Lipectomy was performed and the histological findings demonstrated large dystrophic adipocyte morphology. The patient was recovered uneventfully. CONCLUSION When patients have multiple symmetric lipomatous lesions, clinicians should suspect MSL and survey possible associated conditions, such as alcoholism, liver cirrhosis, dyspnea, and neuropathy in detail.
Collapse
Affiliation(s)
- Kyunghun Jung
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Republic of Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
10
|
Dron JS, Wang J, McIntyre AD, Iacocca MA, Robinson JF, Ban MR, Cao H, Hegele RA. Six years' experience with LipidSeq: clinical and research learnings from a hybrid, targeted sequencing panel for dyslipidemias. BMC Med Genomics 2020; 13:23. [PMID: 32041611 PMCID: PMC7011550 DOI: 10.1186/s12920-020-0669-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In 2013, our laboratory designed a targeted sequencing panel, "LipidSeq", to study the genetic determinants of dyslipidemia and metabolic disorders. Over the last 6 years, we have analyzed 3262 patient samples obtained from our own Lipid Genetics Clinic and international colleagues. Here, we highlight our findings and discuss research benefits and clinical implications of our panel. METHODS LipidSeq targets 69 genes and 185 single-nucleotide polymorphisms (SNPs) either causally related or associated with dyslipidemia and metabolic disorders. This design allows us to simultaneously evaluate monogenic-caused by rare single-nucleotide variants (SNVs) or copy-number variants (CNVs)-and polygenic forms of dyslipidemia. Polygenic determinants were assessed using three polygenic scores, one each for low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol. RESULTS Among 3262 patient samples evaluated, the majority had hypertriglyceridemia (40.1%) and familial hypercholesterolemia (28.3%). Across all samples, we identified 24,931 unique SNVs, including 2205 rare variants predicted disruptive to protein function, and 77 unique CNVs. Considering our own 1466 clinic patients, LipidSeq results have helped in diagnosis and improving treatment options. CONCLUSIONS Our LipidSeq design based on ontology of lipid disorders has enabled robust detection of variants underlying monogenic and polygenic dyslipidemias. In more than 50 publications related to LipidSeq, we have described novel variants, the polygenic nature of many dyslipidemias-some previously thought to be primarily monogenic-and have uncovered novel mechanisms of disease. We further demonstrate several tangible clinical benefits of its use.
Collapse
Affiliation(s)
- Jacqueline S. Dron
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
- Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 5B7 Canada
| | - Jian Wang
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
| | - Adam D. McIntyre
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
| | - Michael A. Iacocca
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
- Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 5B7 Canada
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford University, 450 Serra Mall, Stanford, CA 94305 USA
| | - John F. Robinson
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
| | - Matthew R. Ban
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
| | - Henian Cao
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
| | - Robert A. Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
- Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 5B7 Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5B7 Canada
| |
Collapse
|
11
|
Chen K, Wan X, Zhao L, Zhao S, Peng L, Yang W, Yuan J, Zhu L, Mo Z. Cbl Proto-Oncogene B (CBLB) c.197A>T Mutation Induces Mild Metabolic Dysfunction in Partial Type I Multiple Symmetric Lipomatosis (MSL). Diabetes Metab Syndr Obes 2020; 13:3535-3549. [PMID: 33116705 PMCID: PMC7547790 DOI: 10.2147/dmso.s273780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Multiple symmetric lipomatosis (MSL) is a rare disease showing chronic progression of multiple, symmetrical, and non-encapsulated subcutaneous lipoma. The cause of the disease remains unknown. PATIENTS AND METHODS This study reported and summarized 13 sporadic cases of Type I MSL patients in terms of histopathology and cellular and molecular biology and assessed the CBLB c.197A>T mutation in the IRS1-PI3K-Akt pathway. RESULTS The clinical data showed that these 13 Type I patients were all male with a mean age of 57.0 ± 6.6 years old and consumed alcohol heavily. The laboratory tests revealed that most of the patients had hyperuricemia, diabetes, hyperinsulinemia, or insulin resistance; however, their blood lipid levels were close to a normal range. The imaging data exhibited lipomas that only occurred subcutaneously but not viscerally, ie, Types Ia (15.4%), Ib (30.8%), and Ic (53.8%). The molecular analyses of adipocytes of isoprenaline stimulated human adipose tissue-derived mesenchymal stromal cells (hADSCs) isolated from the adipose tissue lipoma-like masses (ATLLM) demonstrated that these adipocytes did not express UCP-1. The Cbl proto-oncogene B (CBLB), an E3 ubiquitin-protein ligase, was associated with insulin resistance and obesity and was mutated (ie, CBLB c.197A>T) in four MSL patients after the whole genome and Sanger sequencing of the blood samples. Furthermore, the CBLB c.197A>T mutation induced hADSC resistance to insulin by inactivation of the IRS-1-PI3K-AKT pathway. CONCLUSION This study analyzed clinical, histopathological, and cellular and molecular biological characterizations of 13 Type I MSL patients and identified the CBLB c.197A>T heterozygous mutation that could be responsible for MSL metabolic dysfunction or even MSL development.
Collapse
Affiliation(s)
- Ke Chen
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Xinxing Wan
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Liling Zhao
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Shaoli Zhao
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Lin Peng
- Department of Nephrology, The First Hospital of Changsha, Changsha, Hunan410005, People’s Republic of China
| | - Wenjun Yang
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Jingjing Yuan
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Liyong Zhu
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
| | - Zhaohui Mo
- Department of Endocrinology, The Third Xiangya Hospital of Central South University, Changsha, Hunan410013, People’s Republic of China
- Correspondence: Zhaohui Mo Tel/Fax +86 731 88618006 Email
| |
Collapse
|
12
|
El Hasbani G, Assaker R, Nithisoontorn S, Plath W, Lopez EO, Gamarra JV, Kofahi A, Bertely C, Dimitrov V. Madelung's Disease Leading to Presenile Dementia in a Non-alcoholic Patient. Med Arch 2019; 73:285-287. [PMID: 31762567 PMCID: PMC6853722 DOI: 10.5455/medarh.2019.73.285-287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction Madelung's disease (MD) is a rare disorder of unknown etiology defined as the presence of multiple and symmetrical fatty accumulations most commonly involving the upper trunk, neck, and head. Excessive alcohol ingestion has been linked traditionally to the pathogenesis of the disease. The central and peripheral nervous system could both be affected. Presenile dementia, without alcohol abuse, has been rarely reported in the literature as a complication. Aim The aim of this case report is to highlight that multiple symmetric lipomatosis can be complicated by presenile dementia even if the patient is non-alcoholic. Case Report This case report describes a middle age non-alcoholic woman who presented for increased forgetfulness. Brain CT scan showed cerebral and cerebellar atrophy inappropriate for her age. Despite being started on anticholinergic drug, her MMSE decreased 3 points in 1 year. Conclusion Clinicians should consider early onset dementia as a potential complication of Madelung's disease even in patients with no preceding history of alcoholism. A brain MRI and MMSE can aid with identifying such a complication.
Collapse
Affiliation(s)
| | - Richard Assaker
- St. Vincent's Medical Center, Bridgeport, Connecticut, United States of America
| | | | - William Plath
- Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
| | - Edgardo Olvera Lopez
- Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
| | - Jose Vargas Gamarra
- Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
| | - Ahmad Kofahi
- Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
| | - Christopher Bertely
- Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
| | - Vihren Dimitrov
- Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
| |
Collapse
|