Lipodystrophy - it is underdevelopment of the subcutaneous fat layer in the projection of the upper body while an excess accumulation of adipose tissue in the projection of the lower limbs, lower abdomen and buttocks due to severe metabolic disorders.
Lipodystrophy can have both limited and diffuse distribution, and depending on the etiopathogenetic mechanisms of development are the following forms of the disease: gipermuskulyarnaya, diffuse congenital lipodystrophy, progressive segmental, Postinjection painful lipomatosis.
long for lipodystrophy causes of metabolic disorders expressed in the form of insulin resistance diabetes, hypertriglyceridemia and hepatic steatosis.
Despite the rapid development of technology diagnostic branch of medicine, in most cases, can not establish etiopathogenetic factor in the development of lipodystrophy.As precipitating risk factors for some form of degeneration should be considered generalized contagious infection
Congenital and acquired lipodystrophy types found equivalent, mostly women and onset of the disease is necessary, usually at the age of 40 years.
In the course of numerous randomized studies have established several etiopathogenetic theories of lipodystrophy, each of which has the right to exist.
According to the first theory, the body of each patient has an abnormal protein substance having the nature of pituitary origin and has a pronounced zhiromobiliziruyuschimi properties.Authentically impossible to establish a clear relationship between the amount of peptide and abnormal development of lipodystrophy, since there are no laboratory methods of quantification.However, increasing the lipolytic properties of the plasma of patients suffering from lipodystrophy generalized form, it favors the presence of substances in the body of the patient with severe zharomobiliziruyuschim action.
conducted research in the field of endocrinology contributed to the theory of the development of lipodystrophy, which is based on a clear relationship occurrence of violations of subcutaneous fat with increased secretion of growth hormone.According to this theory, the structure of the growth hormone in patients with lipodystrophy the fragment molecule which is characterized by increased zharomobiliziruyuschey activity.
Development signs of lipodystrophy in patients with HIV infection with the growing phenomena of hyperinsulinism is caused by prolonged use of drugs the group of protease inhibitors.
most widespread theory of the origin of lipodystrophy due to the presence of the enzymatic defect, namely congenital absence of triglyceride receptors on the surface of adipocytes.
main pathogenetic mechanisms of lipodystrophy are based on the loss of the ability of the body to the accumulation of neutral fats in physiological fat depots with subsequent development of a generalized lipoatrophy and severe hyperlipidemia.In this disease is only possible elimination of lipids in the liver and gastrointestinal tract, thereby developing fatty liver.In the initial stage of the disease develop secondary compensatory hyperinsulinemia.
Manifestations of lipodystrophy
totality of those or other clinical manifestations determines the total or partial development of forms of lipodystrophy.Total lipodystrophy form is accompanied by a significant reduction in subcutaneous fat in all parts of the body as opposed to partial, in which there are no changes in the subcutaneous tissue of the face.The debut of the disease accounts equivalent to the period of any age from childhood to old age.
view of endogenous development of chronic hyperinsulinemia in the patient occur dysmetabolic violation predetermining the occurrence of typical clinical symptoms.Phenotypic manifestations of lipodystrophy is the development of true skeletal muscle hypertrophy and of moderate prognathism, enlargement of bone distal extremities and regional hypertrichosis.
during the onset of a typical attack patients are concerned hyperinsulinemia which came sharply unmotivated weakness, expressed the feeling of hunger, excessive sweating and a feeling of inner trembling.
lipodystrophy, accompanied by endogenous hyperinsulinemia, increased sclerosis causes parenchymal internal organs of different localization.For lipodystrophy pancreas is not accompanied by clinical symptoms, but during radiological methods of diagnosis revealed focal lesion patterns authority.
Generalized congenital lipodystrophy origin is a rare disease and is more pronounced in girls between 6-7 years.The disease is characterized by sluggish over with minimal changes to the patient's health (a decrease of performance, violation of appetite and insomnia), so patients in this category do not require specific therapy.
Lipodystrophy gipermuskulyarnogo different types of sharp restriction of fat tissue with simultaneous hypertrophy of skeletal muscle.In addition to changes in the muscular apparatus, the patient has expressed headaches, susceptibility to hypertension, increased body hair, and women - dysmenorrhea.This type of lipodystrophy is classified as favorable, and respond well to treatment with symptomatic drug groups.
quite rare and at the same time, the patient severe form of progressive lipodystrophy is segmental.A characteristic feature of this disease is a sharp restriction until the complete absence of subcutaneous fat on any part of the body in the absence of changes in other areas of the body.As a general rule, to establish the correct diagnosis is enough of a visual inspection of the patient.In some cases, segmental loss of subcutaneous fat may be associated with disturbances of bone structures in the area in the form of cysts.With long-term course of the disease in women begin to show symptoms that characterize the hormonal disorders (hypothyroidism, dysmenorrhea).Among curative measures, special attention should be given to methods of physiotherapy treatment.
Lipodystrophy in patients suffering from injecting drug use is common, and the localization of its manifestations has a clear dependence on the place of injection produced, especially after repeated episodes.Due to the constant irritation of receptors is the development of trophic changes, not only the skin but also the subcutaneous fat.A special feature of this form that distinguishes it from all previous ones is that in the injection site may develop as lipoatrophy, and the reverse phenomenon - hypertrophy.In addition to the complete absence of fat in the affected area there is a complete lack of all kinds of sensitivity.
lipodystrophy diabetes, which also belongs to the category of post-injection, in need of treatment with highly purified insulin in combination with a 0.5% solution of novocaine.
This form of the disease is more related to a cosmetic defect, and has a second formulation of "cellulite".Lipodystrophy gynoid type more common in female patients and the depth of subcutaneous tissue disorders tend to be small.According to statistics, at least 90% of women suffer from lipodystrophy gynoid varying degrees of intensity, with the debut of the disease accounts for a maximum period of hormonal activity (puberty, pregnancy, and prolonged use of hormonal contraceptives).
in the development of type gynoid lipodystrophy released several stages, gradually changing each other.In the initial stage of the disease is the formation of dense collagen fibers to form a sept, hampering lymph and blood circulation at the microcirculatory level.Long-term violation of the circulation of blood and lymphatic tissue is accompanied by severe soft tissue swelling.In this step, the defect is not detected lipodystrophy adipose tissue and are more affected collagen synthesis.
symptoms in gynoid lipodystrophy observed only in the third stage, when there is excess adipose tissue proliferation in conjunction with the rapid development of collagen septal walls.Gynoid lipodystrophy mammary glands in the third stage of the disease is also a common disease and is characterized by a double-sided defeat.
terminally lipodystrophy observed not only symptoms of disorders of the skin relief in various areas with the presence of major components of high density regional and discoloration of the skin, but also an expression of pain on palpation.This pathology needs an individual approach to the treatment of patients with specialists narrow profile (beauticians, plastic surgeon, physiotherapist, dietician, endocrinologist).
gynoid lipodystrophy dangerous type of infectious-inflammatory complications of skin with a tendency to nekrotizirovaniyu tissues.
treatment of lipodystrophy
Despite the fact that lipodystrophy has long been singled out as separate entities that have not yet been identified common pathogenesis based treatment of this disease, as etiopathogenesis is not fully understood.
This pathology is classified as general social problems, so an increasing number of research aimed at developing new methods of treatment of lipodystrophy.Currently used symptomatic type of treatment of lipodystrophy, depending on the available clinical manifestations in the patient.
Due to the fact that lipodystrophy different localization often acts as a complication in patients with HIV infection, there have been large-scale randomized study and concluded that the provocateur disorders of lipid metabolism in these patients is prolonged use of drugs "Retrovir "and" Zerit ".In this regard, the first signs of lipodystrophy is a rationale for replacing preparations on their analogs.
Plastic Maxillofacial Surgery offers a wide range of operational benefits for the treatment of lipodystrophy any location.In a situation where there are violations of subcutaneous fat in the limbs or buttocks implants used method of implementation.To eliminate defects of soft tissues using injectable fillers, but it should be borne in mind that this manipulation is a short-term positive effect, and require periodic adjustment.
as medical conservative treatment of lipodystrophy in diabetes medicines used tiazolidionov group, the recovery of the functions of adipocytes.Because these drugs are limited in scope and do not have evidence effectiveness of therapy with their use is rarely used.