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Metreleptin Supplementation for Improving Lipid and Glycemic Profiles in Acquired Diabetes Lipodystrophy: A Case Report.

Authors
  • Nagayama, Ayako1
  • Ashida, Kenji1
  • Moritaka, Kanoko1
  • Hidaka, Mami1
  • Gobaru, Mizuki1
  • Tanaka, Seiji2
  • Hasuzawa, Nao1
  • Akasu, Shoko1
  • Goto, Yuka1
  • Motomura, Seiichi3
  • Hara, Kento1
  • Tsuruta, Munehisa1
  • Wada, Nobuhiko1
  • Nakayama, Hitomi1
  • Tajiri, Yuji3
  • Nomura, Masatoshi1
  • 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan. , (Japan)
  • 2 Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan. , (Japan)
  • 3 Division of Endocrinology and Metabolism, Internal Medicine, Kurume Medical Center, Fukuoka, Japan. , (Japan)
Type
Published Article
Journal
Journal of the Endocrine Society
Publisher
The Endocrine Society
Publication Date
Nov 01, 2019
Volume
3
Issue
11
Pages
2179–2183
Identifiers
DOI: 10.1210/js.2019-00251
PMID: 31720553
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Most childhood cancer survivors who undergo hematopoietic stem cell transplantation subsequently develop impaired glucose tolerance and hypertriglyceridemia. These conditions are presumably associated with total-body irradiation-related acquired lipodystrophy and may lead to cardiovascular disease. Metreleptin (recombinant leptin) may help improve the lipoprotein profile, insulin sensitivity, and quality of life of patients with total-body irradiation-related lipodystrophy. This report describes the safe and effective use of metreleptin supplementation for insulin resistance and dyslipidemia in acquired incomplete lipodystrophy. A 24-year-old Japanese woman with diabetes mellitus and hypertriglyceridemia was admitted to our hospital. She was diagnosed with acute lymphocytic leukemia at 3 years of age and had undergone systemic chemotherapy and total-body irradiation before allogeneic stem cell transplantation. She was also diagnosed with hypertriglyceridemia and diabetes mellitus at 11 years of age. She had a low adiponectin level, low-normal leptin level, and diabetes mellitus with marked insulin resistance. Thus, acquired incomplete lipodystrophy was diagnosed. Her serum triglyceride and lipoprotein profiles improved within 1 month of treatment initiation. Glycemic metabolism and insulin sensitivity in the skeletal muscles improved after 6 months. As previously reported, metreleptin therapy is effective in improving lipid and glycemic profiles in generalized lipodystrophy. In the present case, we considered that metreleptin supplementation could reduce the remnant VLDL cholesterol fraction and improve diabetes mellitus. We conclude that it may be an effective alternative therapy for improving the expected prognosis of patients with acquired incomplete lipodystrophy, including childhood cancer survivors. Copyright © 2019 Endocrine Society.

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