Roux-en-Y Gastric Bypass Surgery in the Management of Familial Partial Lipodystrophy Type 1

TY - JOUR

T1 - Roux-en-Y Gastric Bypass Surgery in the Management of Familial Partial Lipodystrophy Type 1

AU - Melvin, Audrey

AU - Adams, Claire

AU - Flanagan, Catherine

AU - Gaff, Lisa

AU - Gratton, Barbara

AU - Gribble, Fiona

AU - Roberts, Geoffrey

AU - Semple, Robert K.

AU - O'Rahilly, Stephen

AU - Rubino, Francesco

AU - Stears, Anna

AU - Savage, David B.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Context: Familial partial lipodystrophy type 1 (FPLD1) is an extreme form of central adiposity, with peripheral lipodystrophy associated with severe manifestations of the metabolic syndrome, often poorly responsive to standard therapeutic approaches. Body mass index in FPLD1 varies but, in many cases, is below the level at which metabolic surgery is usually considered as a therapeutic option.Design: We detailed the metabolic response to gastric bypass surgery of three patients with FPLD1, refractory to medical therapy.Results: Roux-en-Y gastric bypass (RYGB) was associated with weight loss and substantial improvements in glycemic control and insulin sensitivity. All three patients were able to stop using insulin. Glucose tolerance testing in one patient demonstrated an increase in L-cell-derived gut hormone responses postoperatively.Conclusion: RYGB surgery substantially improved glycemic control in three patients with FPLD1, two of whom had body mass indices below 30 kg/m2. RYGB should be considered in patients with partial lipodystrophy and refractory metabolic disease.

AB - Context: Familial partial lipodystrophy type 1 (FPLD1) is an extreme form of central adiposity, with peripheral lipodystrophy associated with severe manifestations of the metabolic syndrome, often poorly responsive to standard therapeutic approaches. Body mass index in FPLD1 varies but, in many cases, is below the level at which metabolic surgery is usually considered as a therapeutic option.Design: We detailed the metabolic response to gastric bypass surgery of three patients with FPLD1, refractory to medical therapy.Results: Roux-en-Y gastric bypass (RYGB) was associated with weight loss and substantial improvements in glycemic control and insulin sensitivity. All three patients were able to stop using insulin. Glucose tolerance testing in one patient demonstrated an increase in L-cell-derived gut hormone responses postoperatively.Conclusion: RYGB surgery substantially improved glycemic control in three patients with FPLD1, two of whom had body mass indices below 30 kg/m2. RYGB should be considered in patients with partial lipodystrophy and refractory metabolic disease.

UR - http://www.scopus.com/inward/record.url?scp=85032484168&partnerID=8YFLogxK

U2 - 10.1210/jc.2017-01235

DO - 10.1210/jc.2017-01235

M3 - Article

C2 - 28973478

AN - SCOPUS:85032484168

SN - 0021-972X

VL - 102

SP - 3616

EP - 3620

JO - The Journal of clinical endocrinology and metabolism

JF - The Journal of clinical endocrinology and metabolism

IS - 10

ER -