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Lipodystrophy, familial partial, type 9(FPLD9)

MedGen UID:
1845936
Concept ID:
C5882746
Disease or Syndrome
Synonyms: FPLD9; LIPODYSTROPHY, FAMILIAL PARTIAL, TYPE 9
 
Gene (location): PLAAT3 (11q12.3-13.1)
 
Monarch Initiative: MONDO:0958034
OMIM®: 620683

Definition

Familial partial lipodystrophy type 9 (FPLD9) is an autosomal recessive metabolic disorder characterized by the loss of adipose tissue resulting in a lean appearance with muscular hypertrophy, usually most apparent in the limbs and trunk. Some patients have more generalized lipoatrophy, whereas others have abnormal fat accumulation in the face and neck regions and show cushingoid or acromegalic facial features. The disorder is associated with insulin-resistant diabetes mellitus, dyslipidemia, low HDL, and hepatic steatosis. Symptom onset is usually in the first decade. Females tend to have hirsutism and polycystic ovary syndrome, whereas males have gynecomastia. Most patients also have neurologic involvement, including demyelinating polyneuropathy (in most) and delayed development with intellectual disability (in about half) (Schuermans et al., 2023). For a discussion of genetic heterogeneity of familial partial lipodystrophy (FPLD), see 151660. [from OMIM]

Clinical features

From HPO
Arthralgia
MedGen UID:
13917
Concept ID:
C0003862
Sign or Symptom
Joint pain.
Myalgia
MedGen UID:
68541
Concept ID:
C0231528
Sign or Symptom
Pain in muscle.
Polycystic ovaries
MedGen UID:
10836
Concept ID:
C0032460
Disease or Syndrome
Polycystic ovary syndrome is a condition that affects women in their child-bearing years and alters the levels of multiple hormones, resulting in problems affecting many body systems.\n\nMost women with polycystic ovary syndrome produce excess male sex hormones (androgens), a condition called hyperandrogenism. Having too much of these hormones typically leads to excessive body hair growth (hirsutism), acne, and male pattern baldness.\n\nHyperandrogenism and abnormal levels of other sex hormones prevent normal release of egg cells from the ovaries (ovulation) and regular menstrual periods, leading to difficulty conceiving a child (subfertility) or a complete inability to conceive (infertility). For those who achieve pregnancy, there is an increased risk of complications and pregnancy loss. Due to irregular and infrequent menstruation and hormone abnormalities, affected women have an increased risk of cancer of the uterine lining (endometrial cancer).\n\nIn polycystic ovary syndrome, one or both ovaries can contain multiple small, immature ovarian follicles that can appear as cysts on medical imaging. Normally, ovarian follicles contain egg cells, which are released during ovulation. In polycystic ovary syndrome, abnormal hormone levels prevent follicles from growing and maturing to release egg cells. Instead, these immature follicles accumulate in the ovaries. Affected women can have 12 or more of these follicles. The number of these follicles usually decreases with age.\n\nAbout half of all women with polycystic ovary syndrome are overweight or have obesity and are at increased risk of a fatty liver. Additionally, many women with polycystic ovary syndrome have elevated levels of insulin, which is a hormone that helps control levels of blood glucose, also called blood sugar. By age 40, about 10 percent of overweight women with polycystic ovary syndrome develop abnormally high blood glucose levels (type 2 diabetes), and up to 35 percent develop prediabetes (higher-than-normal blood glucose levels that do not reach the cutoff for diabetes). Obesity and increased insulin levels (hyperinsulinemia) further increase the production of androgens in polycystic ovary syndrome.\n\nWomen with polycystic ovary syndrome are also at increased risk for developing metabolic syndrome, which is a group of conditions that include high blood pressure (hypertension), increased belly fat, high levels of unhealthy fats and low levels of healthy fats in the blood, and high blood glucose levels. About 20 percent of affected adults experience pauses in breathing during sleep (sleep apnea). Women with polycystic ovary syndrome are more likely than women in the general popluation to have mood disorders such as depression.
Genu valgum
MedGen UID:
154364
Concept ID:
C0576093
Anatomical Abnormality
The legs angle inward, such that the knees are close together and the ankles far apart.
Pes cavus
MedGen UID:
675590
Concept ID:
C0728829
Congenital Abnormality
An increase in height of the medial longitudinal arch of the foot that does not flatten on weight bearing (i.e., a distinctly hollow form of the sole of the foot when it is bearing weight).
2-3 toe syndactyly
MedGen UID:
1645640
Concept ID:
C4551570
Congenital Abnormality
Syndactyly with fusion of toes two and three.
Hypertensive disorder
MedGen UID:
6969
Concept ID:
C0020538
Disease or Syndrome
The presence of chronic increased pressure in the systemic arterial system.
Short stature
MedGen UID:
87607
Concept ID:
C0349588
Finding
A height below that which is expected according to age and gender norms. Although there is no universally accepted definition of short stature, many refer to "short stature" as height more than 2 standard deviations below the mean for age and gender (or below the 3rd percentile for age and gender dependent norms).
Acral overgrowth
MedGen UID:
1789172
Concept ID:
C1735881
Disease or Syndrome
Excessive growth of hands and feet (predominantly due to soft tissue swelling). Typical manifestations include shoe size increase, foot enlargement, glove tightness, and hand enlargement.
Hepatomegaly
MedGen UID:
42428
Concept ID:
C0019209
Finding
Abnormally increased size of the liver.
Hepatic steatosis
MedGen UID:
398225
Concept ID:
C2711227
Disease or Syndrome
Steatosis is a term used to denote lipid accumulation within hepatocytes.
Low-set ears
MedGen UID:
65980
Concept ID:
C0239234
Congenital Abnormality
Upper insertion of the ear to the scalp below an imaginary horizontal line drawn between the inner canthi of the eye and extending posteriorly to the ear.
Migraine
MedGen UID:
57451
Concept ID:
C0149931
Disease or Syndrome
Migraine is a chronic neurological disorder characterized by episodic attacks of headache and associated symptoms.
Spastic gait
MedGen UID:
115907
Concept ID:
C0231687
Finding
Spasticity is manifested by increased stretch reflex which is intensified with movement velocity. This results in excessive and inappropriate muscle activation which can contribute to muscle hypertonia. Spastic gait is characterized by manifestations such as muscle hypertonia, stiff knee, and circumduction of the leg.
Areflexia
MedGen UID:
115943
Concept ID:
C0234146
Finding
Absence of neurologic reflexes such as the knee-jerk reaction.
Demyelinating peripheral neuropathy
MedGen UID:
82859
Concept ID:
C0270922
Disease or Syndrome
Demyelinating neuropathy is characterized by slow nerve conduction velocities with reduced amplitudes of sensory/motor nerve conduction and prolonged distal latencies.
Tip-toe gait
MedGen UID:
98104
Concept ID:
C0427144
Finding
An abnormal gait pattern characterized by the failure of the heel to contact the floor at the onset of stance during gait.
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Chiari type I malformation
MedGen UID:
196689
Concept ID:
C0750929
Congenital Abnormality
Arnold-Chiari type I malformation refers to a relatively mild degree of herniation of the posteroinferior region of the cerebellum (the cerebellar tonsils) into the cervical canal with little or no displacement of the fourth ventricle. It is characterized by one or both pointed (not rounded) cerebellar tonsils that project 5 mm below the foramen magnum, measured by a line drawn from the basion to the opisthion (McRae Line)
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Elevated hemoglobin A1c
MedGen UID:
892798
Concept ID:
C4073162
Finding
An increased concentration of hemoglobin A1c (HbA1c), which is the product of nonenzymatic attachment of a hexose molecule to the N-terminal amino acid of the hemoglobin molecule. This reaction is dependent on blood glucose concentration, and therefore reflects the mean glucose concentration over the previous 8 to 12 weeks. The HbA1c level provides a better indication of long-term glycemic control than one-time blood or urinary glucose measurements.
Kyphosis
MedGen UID:
44042
Concept ID:
C0022821
Anatomical Abnormality
Exaggerated anterior convexity of the thoracic vertebral column.
Lipodystrophy
MedGen UID:
6111
Concept ID:
C0023787
Disease or Syndrome
Degenerative changes of the fat tissue.
Hyperlordosis
MedGen UID:
9805
Concept ID:
C0024003
Finding
Abnormally increased curvature (anterior concavity) of the lumbar or cervical spine.
Scoliosis
MedGen UID:
11348
Concept ID:
C0036439
Disease or Syndrome
The presence of an abnormal lateral curvature of the spine.
Achilles tendon contracture
MedGen UID:
98052
Concept ID:
C0410264
Anatomical Abnormality
A contracture of the Achilles tendon.
Lipoatrophy
MedGen UID:
488959
Concept ID:
C1280433
Disease or Syndrome
Localized loss of fat tissue.
Skeletal muscle hypertrophy
MedGen UID:
853739
Concept ID:
C2265792
Finding
Abnormal increase in muscle size and mass not due to training.
Hyperglycemia
MedGen UID:
5689
Concept ID:
C0020456
Disease or Syndrome
An increased concentration of glucose in the blood.
Decreased HDL cholesterol concentration
MedGen UID:
57731
Concept ID:
C0151691
Finding
An decreased concentration of high-density lipoprotein cholesterol in the blood.
Hypertriglyceridemia
MedGen UID:
167238
Concept ID:
C0813230
Finding
An abnormal increase in the level of triglycerides in the blood.
Insulin-resistant diabetes mellitus
MedGen UID:
163439
Concept ID:
C0854110
Disease or Syndrome
A type of diabetes mellitus related not to lack of insulin but rather to lack of response to insulin on the part of the target tissues of insulin such as muscle, fat, and liver cells. This type of diabetes is typically associated with increases both in blood glucose concentrations as well as in fasting and postprandial serum insulin levels.
Convex nasal ridge
MedGen UID:
66809
Concept ID:
C0240538
Finding
Nasal ridge curving anteriorly to an imaginary line that connects the nasal root and tip. The nose appears often also prominent, and the columella low.
Mandibular prognathia
MedGen UID:
98316
Concept ID:
C0399526
Finding
Abnormal prominence of the chin related to increased length of the mandible.
Prominent nose
MedGen UID:
98423
Concept ID:
C0426415
Finding
Distance between subnasale and pronasale more than two standard deviations above the mean, or alternatively, an apparently increased anterior protrusion of the nasal tip.
Short neck
MedGen UID:
99267
Concept ID:
C0521525
Finding
Diminished length of the neck.
Flat forehead
MedGen UID:
347463
Concept ID:
C1857485
Finding
A forehead with abnormal flatness.
Acanthosis nigricans
MedGen UID:
54
Concept ID:
C0000889
Disease or Syndrome
A dermatosis characterized by thickened, hyperpigmented plaques, typically on the intertriginous surfaces and neck.
Hirsutism
MedGen UID:
42461
Concept ID:
C0019572
Disease or Syndrome
Abnormally increased hair growth referring to a male pattern of body hair (androgenic hair).
Hyperinsulinemia
MedGen UID:
43779
Concept ID:
C0020459
Disease or Syndrome
An increased concentration of insulin in the blood.
Hypothyroidism
MedGen UID:
6991
Concept ID:
C0020676
Disease or Syndrome
Deficiency of thyroid hormone.
Precocious puberty
MedGen UID:
18752
Concept ID:
C0034013
Disease or Syndrome
The onset of secondary sexual characteristics before a normal age. Although it is difficult to define normal age ranges because of the marked variation with which puberty begins in normal children, precocious puberty can be defined as the onset of puberty before the age of 8 years in girls or 9 years in boys.
Gynecomastia
MedGen UID:
6694
Concept ID:
C0018418
Disease or Syndrome
Abnormal development of large mammary glands in males resulting in breast enlargement.
Deeply set eye
MedGen UID:
473112
Concept ID:
C0423224
Finding
An eye that is more deeply recessed into the plane of the face than is typical.

Professional guidelines

PubMed

Sekizkardes H, Cochran E, Malandrino N, Garg A, Brown RJ
J Clin Endocrinol Metab 2019 Aug 1;104(8):3068-3076. doi: 10.1210/jc.2018-02787. PMID: 31194872Free PMC Article
Chait A, Eckel RH
Ann Intern Med 2019 May 7;170(9):626-634. Epub 2019 Apr 30 doi: 10.7326/M19-0203. PMID: 31035285
Araujo-Vilar D, Sánchez-Iglesias S, Guillín-Amarelle C, Castro A, Lage M, Pazos M, Rial JM, Blasco J, Guillén-Navarro E, Domingo-Jiménez R, del Campo MR, González-Méndez B, Casanueva FF
Endocrine 2015 May;49(1):139-47. Epub 2014 Nov 4 doi: 10.1007/s12020-014-0450-4. PMID: 25367549Free PMC Article

Recent clinical studies

Etiology

Agrawal S, Luan J, Cummings BB, Weiss EJ, Wareham NJ, Khera AV
Diabetes 2024 Jul 1;73(7):1099-1111. doi: 10.2337/db23-0575. PMID: 38345889Free PMC Article
Loh WJ, Yaligar J, Hooper AJ, Sadananthan SA, Kway Y, Lim SC, Watts GF, Velan SS, Leow MKS, Khoo J
Nutr Diabetes 2024 Feb 6;14(1):3. doi: 10.1038/s41387-024-00260-y. PMID: 38321009Free PMC Article
Eldin AJ, Akinci B, da Rocha AM, Meral R, Simsir IY, Adiyaman SC, Ozpelit E, Bhave N, Gen R, Yurekli B, Ozdemir Kutbay N, Siklar Z, Neidert AH, Hench R, Tayeh MK, Innis JW, Jalife J, Oral H, Oral EA
Clin Endocrinol (Oxf) 2021 Jun;94(6):1043-1053. Epub 2021 Feb 22 doi: 10.1111/cen.14426. PMID: 33502018Free PMC Article
Sekizkardes H, Cochran E, Malandrino N, Garg A, Brown RJ
J Clin Endocrinol Metab 2019 Aug 1;104(8):3068-3076. doi: 10.1210/jc.2018-02787. PMID: 31194872Free PMC Article
Chait A, Eckel RH
Ann Intern Med 2019 May 7;170(9):626-634. Epub 2019 Apr 30 doi: 10.7326/M19-0203. PMID: 31035285

Diagnosis

Soares RMV, da Silva MA, Campos JTAM, Lima JG
Front Endocrinol (Lausanne) 2024;15:1394102. Epub 2024 Sep 27 doi: 10.3389/fendo.2024.1394102. PMID: 39398333Free PMC Article
Loh WJ, Yaligar J, Hooper AJ, Sadananthan SA, Kway Y, Lim SC, Watts GF, Velan SS, Leow MKS, Khoo J
Nutr Diabetes 2024 Feb 6;14(1):3. doi: 10.1038/s41387-024-00260-y. PMID: 38321009Free PMC Article
Varlet AA, Helfer E, Badens C
Cells 2020 Aug 23;9(9) doi: 10.3390/cells9091947. PMID: 32842478Free PMC Article
Laver TW, Patel KA, Colclough K, Curran J, Dale J, Davis N, Savage DB, Flanagan SE, Ellard S, Hattersley AT, Weedon MN
J Clin Endocrinol Metab 2018 Sep 1;103(9):3225-3230. doi: 10.1210/jc.2017-02662. PMID: 30020498Free PMC Article
Guillín-Amarelle C, Fernández-Pombo A, Sánchez-Iglesias S, Araújo-Vilar D
Nucleus 2018 Jan 1;9(1):249-260. doi: 10.1080/19491034.2018.1454167. PMID: 29557732Free PMC Article

Therapy

Lambadiari V, Kountouri A, Maratou E, Liatis S, Dimitriadis GD, Karpe F
Front Endocrinol (Lausanne) 2021;12:684182. Epub 2021 Jun 8 doi: 10.3389/fendo.2021.684182. PMID: 34168618Free PMC Article
Sekizkardes H, Cochran E, Malandrino N, Garg A, Brown RJ
J Clin Endocrinol Metab 2019 Aug 1;104(8):3068-3076. doi: 10.1210/jc.2018-02787. PMID: 31194872Free PMC Article
Chait A, Eckel RH
Ann Intern Med 2019 May 7;170(9):626-634. Epub 2019 Apr 30 doi: 10.7326/M19-0203. PMID: 31035285
Araujo-Vilar D, Sánchez-Iglesias S, Guillín-Amarelle C, Castro A, Lage M, Pazos M, Rial JM, Blasco J, Guillén-Navarro E, Domingo-Jiménez R, del Campo MR, González-Méndez B, Casanueva FF
Endocrine 2015 May;49(1):139-47. Epub 2014 Nov 4 doi: 10.1007/s12020-014-0450-4. PMID: 25367549Free PMC Article
Hegele RA, Cao H, Huff MW, Anderson CM
J Clin Endocrinol Metab 2000 Sep;85(9):3089-93. doi: 10.1210/jcem.85.9.6768. PMID: 10999791

Prognosis

Agrawal S, Luan J, Cummings BB, Weiss EJ, Wareham NJ, Khera AV
Diabetes 2024 Jul 1;73(7):1099-1111. doi: 10.2337/db23-0575. PMID: 38345889Free PMC Article
Sekizkardes H, Cochran E, Malandrino N, Garg A, Brown RJ
J Clin Endocrinol Metab 2019 Aug 1;104(8):3068-3076. doi: 10.1210/jc.2018-02787. PMID: 31194872Free PMC Article
Laver TW, Patel KA, Colclough K, Curran J, Dale J, Davis N, Savage DB, Flanagan SE, Ellard S, Hattersley AT, Weedon MN
J Clin Endocrinol Metab 2018 Sep 1;103(9):3225-3230. doi: 10.1210/jc.2017-02662. PMID: 30020498Free PMC Article
Araujo-Vilar D, Sánchez-Iglesias S, Guillín-Amarelle C, Castro A, Lage M, Pazos M, Rial JM, Blasco J, Guillén-Navarro E, Domingo-Jiménez R, del Campo MR, González-Méndez B, Casanueva FF
Endocrine 2015 May;49(1):139-47. Epub 2014 Nov 4 doi: 10.1007/s12020-014-0450-4. PMID: 25367549Free PMC Article
Weterings AA, van Rijsingen IA, Plomp AS, Zwinderman AH, Lekanne Deprez RH, Mannens MM, van den Bergh Weerman MA, van der Wal AC, Pinto-Sietsma SJ
Atherosclerosis 2013 Jul;229(1):169-73. Epub 2013 Apr 20 doi: 10.1016/j.atherosclerosis.2013.04.016. PMID: 23659872

Clinical prediction guides

Soares RMV, da Silva MA, Campos JTAM, Lima JG
Front Endocrinol (Lausanne) 2024;15:1394102. Epub 2024 Sep 27 doi: 10.3389/fendo.2024.1394102. PMID: 39398333Free PMC Article
Guidorizzi NR, Valerio CM, Viola LF, Veras VR, Fernandes VO, Lima GEDCP, Flor AC, Araújo JS, Gonçalves Muniz RB, Moreira RO, De Paula FJA, Zajdenverg L, Dantas JR, Godoy-Matos AF, Montenegro Júnior RM, Foss-Freitas MC
Front Endocrinol (Lausanne) 2024;15:1359211. Epub 2024 Jun 3 doi: 10.3389/fendo.2024.1359211. PMID: 38887266Free PMC Article
Loh WJ, Yaligar J, Hooper AJ, Sadananthan SA, Kway Y, Lim SC, Watts GF, Velan SS, Leow MKS, Khoo J
Nutr Diabetes 2024 Feb 6;14(1):3. doi: 10.1038/s41387-024-00260-y. PMID: 38321009Free PMC Article
Laver TW, Patel KA, Colclough K, Curran J, Dale J, Davis N, Savage DB, Flanagan SE, Ellard S, Hattersley AT, Weedon MN
J Clin Endocrinol Metab 2018 Sep 1;103(9):3225-3230. doi: 10.1210/jc.2017-02662. PMID: 30020498Free PMC Article
Wehnert MS, Bonne G
Semin Pediatr Neurol 2002 Jun;9(2):100-7. doi: 10.1053/spen.2002.33806. PMID: 12138994

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