👤 Anuradha Khadilkar

A female patient from India was diagnosed with diabetes at 16 years of age and presented to a tertiary care diabetes clinic nine months later with hyperglycemia and dyslipidemia (hypercholesterolemia and hypertriglyceridemia), while on insulin and statin therapy. The striking feature was the presence of lipodystrophy on both her upper and lower limbs. Both her elder brother and mother showed the presence of dyslipidemia and a normal phenotype on cascade screening. All three of them had a normal BMI. Managing the case was challenging due to the suboptimal response of dyslipidemia to the various combinations of medication. Genetic testing revealed a rare mutation in the LPL gene, causing familial combined hyperlipidemia (FCH) with an unusual association of lipodystrophy. A similar heterozygous mutation was found in the mother. We report the first case of FCH with lipodystrophy from India and share the challenges encountered during the three years of follow-up. Show less

To screen for variants in the MC4R and LEP genes in 46 patients with clinical suspicion of non-syndromic early onset severe obesity (NEOSO). Children with early onset obesity satisfying WHO criteria of obesity were studied. The MC4R and LEP genes were sequenced using a PCR amplicon based NGS on Illumina MiSeq next generation sequencer using an in-house developed protocol. Of the 46 children tested, four were found to have novel pathogenic/likely-pathogenic variants (one in the MC4R gene and three in the LEP gene). In three out of the 4 families, the presence of the variants was confirmed using standard bidirectional capillary sequencing in the probands. Four children with novel likely pathogenic variants in the MC4R and LEP genes are reported. Genetic analysis is crucial in children with early onset obesity and should be considered. Show less