Multiple Symmetric Lipomatosis
A paradigm of metabolically innocent obesity?
- Michael Haap, MD1,
- Cornelia Siewecke, MD2,
- Claus Thamer, MD1,
- Jürgen Machann, PHD3,
- Fritz Schick, MD, PHD3,
- Hans-U. Häring, MD1,
- Rolf M. Szeimies, MD2 and
- Michael Stumvoll, MD1
- 1Department of Endocrinology, Metabolism and Pathobiochemistry, University of Tübingen, Tübingen, Germany
- 2Department of Dermatology, University of Regensburg, Regensburg, Germany
- 3Section of Experimental Radiology, University of Tübingen, Tübingen, Germany
- Address correspondence and reprint requests to Michael Stumvoll, MD, Medizinische Universitätsklinik, Otfried-Müller-Str. 10, D-72076 Tübingen, Germany. E-mail: michael.stumvoll{at}med.uni-tuebingen.de
Excessive fat storage (obesity) is associated with insulin resistance and type 2 diabetes (1). Paradoxically, inability to store fat (lipodystrophy) is also associated with insulin resistance (2). In both obesity and lipodystrophy, the adipocyte’s storage capacity is exceeded and lipids accumulate in liver, muscle, and β-cells. Hypothetically, if adipose tissue had an intrinsic propensity to proliferate, rather than passively respond to energy excess, calories should be extracted from the circulation and the system should become (or remain) insulin sensitive. Such a process would be particularly effective if it occurred preferentially in subcutaneous adipose tissue, which, metabolically, is the least harmful site (3).
RESEARCH DESIGN AND METHODS
We performed extensive metabolic studies in two patients (Table 1) with multiple symmetric lipomatosis (MSL), a condition characterized by regional excess of subcutaneous adipose tissue (4).
Patient 1 had massive symmetrical subcutaneous fat accumulation in the thoracic, abdominal, and upper arm region (Fig. 1A) that had begun to develop about 15 years earlier. Patient …
