Lipoatrophy

Lipoatrophy- Lipoatrophy is the breakdown of adipose tissue at the insulin injection site causing a depression in the skin. 

Lipodystrophy Rarely, administration of insulin subcutaneously can result in lipoatrophy (depression in the skin) or lipohypertrophy (enlargement or thickening of tissue). 

TDF-renal tubular acidosis D4T-neuropathy, lactic acidosis, lipoatrophy... 

Three cases of severe lipoatrophy, one also with leukoderma, occurring within the same family after intramuscular injection of triamcinolone, suggested genetic susceptibility to this adverse effect (SEDA-3, 303). 

Lipodystrophy, lipoatrophy, or lipohypcrtrophy can be a consequence of chronic local insulin reactions that can be elicited by less pure as well as by highly purified preparations (140), but such reactions can also develop at sites distant to the injection. 

Lipoatrophy, although rare, has been reported in patients using both regular and lispro insulin in CSII pumps (198,199). 

Jones GR, Statham B, Owens DR, Jones MK, Hayes TM. Lipoatrophy and monocomponent porcine insulin. BMJ (Clin Res Ed) 1981 282(6259) 190. 

Griffin ME, Feder A, Tamborlane WV. Lipoatrophy associated with lispro in insulin pump therapy. Diabetes Care 2001 24 174. 

Lipoatrophy due to insulin lispro during pump therapy has been reported before [SEDA-25,510 SEDA-27,449]. 

A 35-year-old woman transferred from regular insulin to insulin lispro, as she had developed unawareness of hypoglycemia (32). After 23 months she developed a circumscribed area of lipoatrophy about 3 cm in diameter at an injection site on the right thigh. Her antiinsulin antibodies were high (50%). Six months later... 

Lipoatrophy has previously been reported with lispro (SEDA-27, 449). 

A 35-year-old woman with type 1 diabetes was transferred after 7 years to lispro subcutaneously tds and NPH twice daily (33). Within 2 years she developed lipoatrophy and further lipoatrophy at another site 6 months later. 

Two cases of lipoatrophy induced by insulin lispro during continuous subcutaneous insulin infusion have been reported (28). 

A 51-year-old woman started to use continuous subcutaneous insulin and after 2 years the insulin was changed to insulin lispro. She developed lipoatrophy in the abdomen and buttocks 1 year later and there was an increase in the time before the bolus started to peak. Buffered regular human insulin stopped progression of the lipoatrophy. 

Insulin lispro can cause lipoatrophy, but it was less extensive in a case in which it had occurred with regular insulin, perhaps because of the greater solubility of insulin lispro. 

Ampudia-Blasco FJ, Hasbum B, Carmena R. A new case of lipoatrophy with lispro insulin in insulin pump therapy is there any insulin preparation free of complications Diabetes Care 2003 26(3) 953-4. 

Arranz AA, Andia V, Lopez-Guzman A. A case of lipoatrophy with lispro insulin without insulin pump therapy. Diabetes Care 2004 27 625-6. 

In a placebo-controlled study in 108 non-diabetic adults with HIV-1 infection and lipoatrophy, rosiglitazone 4 mg/ day for 48 weeks had no beneficial effect on the lipoatrophy (87). However 30 of those who took rosiglitazone developed hypertriglyceridemia, compared with 20 taking placebo, and 11 developed hypercholesterolemia, compared with four taking placebo. 

Mafong DD, Lee GA, Yu S, Tien P, Mauro T, Grunfeld C. Development of multiple lipomas during treatment with rosiglitazone in a patient with HTV-associated lipoatrophy. AIDS 2004 18 1742-4. 

Atmaca A, Erbas, T. Lipoatrophy induced by subcutaneous administration of octreotide in the treatment of acromegaly. Exp Clin Endocrinol Diabetes 2005 113 340-3. 

Injection site reactions to somatropin are common and include nodules, pain, and erythema. They usually resolve spontaneously (25,34). In a 2-year study of once- or twice-monthly injections of a modified-release formulation of somatropin in 56 prepubertal children, injection site reactions were common, especially in the first year of treatment. These included skin nodules in 56% of injections, erythema in 49%, and lipoatrophy in 12% (70). 

Lipoatrophy, a transient loss of subcutaneous fat identifiable as skin dimpling, occurred in 11% of injections in 75 children who were given modified-release somatropin for 12 months (25) and in one of 68 children in another study (34). Site rotation is recommended to prevent lipodystrophy. 

Dyslipidemia is a common accompaniment of the lipodystrophy syndrome observed in HIV-infected patients. This syndrome presents as a combination of peripheral lipoatrophy and the metabolic syndrome (central adiposity, insulin resistance, and dyslipidemia). The term lipodystrophy syndrome was first used in two case reports to describe a clinical picture of subcutaneous fat wasting in the face and limbs of HIV infected patients treated with indinavir, reminiscent of the rare congenital lipodystrophy syndromes (138,139). In addition, benign symmetric lipomatoses on the trunk and neck were described. A systematic study of this syndrome in the Australian HIV cohort showed co-existence of peripheral lipoatrophy with abdominal visceral obesity, dyslipidemia, and insulin resistance in HIV-infected patients with or without treatment with protease inhibitors (140). 

In a retrospective analysis of 36 patients who switched from stavudine to tenofovir while HIV RNA was below 20 copies/ ml for more than 6 months, two switched because of peripheral neuropathy and 34 because of lipoatrophy the median duration of observation was 36 weeks (158). There was a significant fall in cholesterol concentrations from 5.5 mmol/1 to 5.0 mmol/1 at week 4, and 4.7 mmol/1 at week 36. There was also a non-significant trend toward a fall in triglyceride concentrations. 

Lipoatrophy can occur after the injection of some drugs, including penicillin (933). 

Garcia-Benayas T, Blanco F, de la Cruz JJ, Soriano V, Gonzalez-Lahoz J. Replacing stavudine by abacavir reduces lactate levels and may improve lipoatrophy. AIDS 2003 17 921-4. 

Moyle GJ, Baldwin C, Langroudi B, Mandalia S, Gazzard BG. A 48-week, randomized, open-label comparison of three abacavir-based substitution approaches in the management of dyslipidemia and peripheral lipoatrophy. J Acquir Immune Defic Syndr 2003 33 22-8. 

Kuperman-Beade M, Laude TA. Partial lipoatrophy in a child. Pediatr Dermatol 2000 17(4) 302-3. 

Nolan D, Mallal S. Antiretroviral-therapy-associated lipoatrophy current status and future directions. Sex Health. 2005 2 153-163. 

Yamauchi T, Kamon J, Waki H, et al. The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat Med 2001 7 941-946. 

Vinson, C., Reitman, M. L., Kagechika, H., Shudo, K., Yoda, M., Nakano, Y., Tobe, K., Nagai, R., Kimura, S., Tomita, M., Froguel, P., and Kadowaki, T. 2001. The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat. Med,., 7, 941-946. 

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