LIPODYSTROPHY (lipodystrophia; Greek lipos fat + dystrophy) — total or local defeat of hypodermic cellulose with reduction of volume of fatty tissue (an atrophic form) or increase in its volume (a hypertrophic form) in the struck area. L. can be generalized or segmented. The concept «lipodystrophy» combines the following patol, states: inborn generalized L., gipermuskulyarny L., progressing segmented L. (a synonym Barraker's disease — Simmons), post-injection L., painful lipomatoz (see. Derkuma disease ).
Inborn generalized lipodystrophy it is characterized by total disappearance of fat in hypodermic cellulose. A disease it meets extremely seldom. The etiology and its pathogeny are unknown. Develops at women more often. There are no specific complaints; weakness, slackness, a chill, anorexia, locks, a depression is noted. In some cases — disturbance of sweating, frustration of a dream. Therapy palliative. The forecast for life favorable.
Gipermuskulyarny lipodystrophy it is characterized by generalized disappearance of fat in hypodermic cellulose with simultaneous excessive development of skeletal muscles. The etiology and a pathogeny are not clear. In the USSR this form is described in 1972 by H. T. Starkova with sotr., observing this form L. at several women. Along with total disappearance of subcutaneous fat and excessive development of muscles the polycystosis of ovaries, headaches and increase in the ABP is observed, hirsutism (see), disturbance of tolerance to glucose. Elements are sometimes observed acromegalias (see), virilescence (see), disturbance of a menstrual cycle. Patol, anatomy is not studied. Pathogenetic treatment and prevention are not developed. The differential diagnosis needs to be carried out with so-called lipoatrofichesky diabetes, at Krom disbolism with a generalized lipoatrophia, cirrhosis are noted, growth is lower than norm, a hypertrophy of skeletal muscles, a pathogeny the cut is insufficiently clear. The forecast for life favorable.
The progressing segmented lipodystrophy J. Morganyi, then in 1906 by R. J. A. Barraquer and in 1911 A. Simons was described at the beginning of 18 century. Both authors described the same patient, the disease belongs to rare forms of defeat fatty tissue (see). More often women are ill.
The etiology and a pathogeny are insufficiently clear. It is supposed that progressing L. it is connected with genetic disorders; there are data on a possibility of defeats of diencephalic area. Patol, anatomy is not studied. Histologically the atrophy of fatty tissue, fibrosis is defined. The symptomatology consists in an atrophy of fatty tissue on limited sites at kept or even the raised adiposity in other sites. The atrophy of a fatty tissue on a face and an upper half of a trunk is more often observed; sometimes the shin or a hip is surprised. Occasionally progressing L. it is combined with an otosclerosis, cystous changes of bones and moronity that connect with genetic disorders. Often changes of water exchange, frustration of a menstrual cycle, vasculomotor disturbances, a hyperthyroidism are at the same time observed. The differential diagnosis is carried out with pubertal exhaustion, neurogenic anorexia.
Pathogenetic treatment is not developed; from palliative methods apply physical therapy, massage, sedatives. The forecast for life favorable; prevention is not developed.
Post-injection lipodystrophy — the most frequent form L. Depishem and Barborkoy is described in 1926 (F. Depisch, Page J. Barborka). The disease is characterized by existence of L. in places of repeated injections. The pathogeny is insufficiently clear. According to the neurogenic and dystrophic concept, the lipoatrophia is connected with the repeated repeated irritation of nervous structures in a zone of an injection caused by chemical, thermal, mechanical influence physical. - chemical properties of the injected medicine, and also with local allergic reactions. Risk of development post-injection L. increases if injections do on a limited body part for a long time. As a result of chronic irritation trophic changes of skin and hypodermic cellulose are found.
Post-injection L. meets more often at women, it is preferential in the form of a lipoatrophia; however cases of a hypertrophy of a fatty tissue in places of injections are described. Cases of a combination of an atrophy and a hypertrophy of a fatty tissue meet.
Thickness of hypodermic cellulose at a lipoatrophia decreases up to total disappearance of fat. In zones of defeat develop a hypesthesia, the hyperesthesia of skin is more rare.
The diagnosis is based on a wedge, symptoms and data of the anamnesis. Treatment is carried out by drugs of pork insulin (see), possessing the lipogenous action which was more expressed in comparison with other drugs of insulin; it is entered into sites of an atrophy in a dose 4 — 5 PIECES. In some cases insulin is mixed with the equal number (1 — 2 ml) of 0,5% of solution of novocaine. Massage, physical therapy is sometimes applied. Prevention: at repeated injections during one course observance of distance between places of pricks and the maximum shchazheniye of fabrics.
Bibliography: Leytes S. M. and Lapteva H. H. Sketches on a pathophysiology of a metabolism and endocrine system, page 99, M., 1967; Potemkinv. V. Endokrinologiya, M., 1972; The Guide to clinical endocrinology, under the editorship of V. G. Baranov, page 578, L., 1977; The Guide to endocrinology, under the editorship of B. V. Alyoshin, etc., page 83, M., 1973; Starkova H. T. Fundamentals of clinical andrology, M., 1973; V. V Talents. Post-injection insulin lipoatrophias, Owls. medical, No. 6, page 104, 1978, bibliogr.; Derot M. et Goury-Laffont M. Les maladies de la nutrition, P., 1970; Labhart A. Klinik der inneren Sekretion, B. — N. Y., 1971; Textbook of endocrinology, ed. by R. H. Williams, Philadelphia, 1974.
V. V. Talantov.