Rare adipose disorders (RADs) masquerading as obesity

Department of Medicine, University of California-San Diego and Veterans' Affairs San Diego Healthcare System, CA, USA.
Acta Pharmacologica Sinica (Impact Factor: 2.91). 02/2012; 33(2):155-72. DOI: 10.1038/aps.2011.153
Source: PubMed


Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum's disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone. In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidence-based data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.

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    • "These disorders differ in whether or not pain is present and in the location of fatty masses [10,16,19]. The pathophysiology of RADs is believed to be different from the generalized accumulation of fat in obesity because the abnormal SAT follows discrete patterns, can occur in both obese and non-obese individuals [10,20], may include loss of normal fat (as in MSL)[21], and may involve alterations of the lymphatic system [21,22]. A previous study suggested that inflammation is involved in the selective expansion of the adipose tissue in DD through elevated interleukin IL-6 expression in affected SAT, and increased blood IL-13 levels in DD women compared to controls [23]. "
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