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Case Study: Hypertriglyceridemia in a Woman With Insulin Resistance

	Presentation

 
B.L. is a 24-year-old woman with a history of dermatomyositis diagnosed at age 3. She received treatment with cyclophosphamide (Cytoxan), metho-trexate, and prednisone until she was 11 years old with successful remission.

When she was 16 years old, she presented with lipoatrophic facial features, hirsutism, amenorrhea, and acanthosis nigricans in the axillary and groin areas. She was lean and muscular but not virilized. An oral glucose tolerance test showed fasting glucose of 159 mg/dl and insulin of 538 µu/ml (normal <10 µu/ml) and 2-h glucose of 300 mg/dl, which is diagnostic of diabetes and suggestive of insulin resistance. Her insulin receptor antibody titers were checked twice and were negative on both occasions. TSH was normal. Testosterone was 1.6 mg/ml (normal 0.10–0.90 mg/ml). Serum cholesterol was 315 mg/dl, and triglycerides were 2,748 mg/dl.

Her mother and maternal grandmother had type 2 diabetes, and her father had dyslipidemia.

B.L. was diagnosed as having type A syndrome of insulin resistance and treated with leuprolide (Lupron), 7.5 mg intramuscularly each month, and advised to follow a low-fat (20%) diet. A year later, her testosterone levels had normalized to 0.17 ng/ml with suppressed gonadotropin levels. Triglyceride and total cholesterol levels had fallen to 2,117 mg/dl and 216 mg/dl, respectively. Her HbA_1c concentration was 6.5%.

Given concern for future osteopenia with the use of a GnRH antagonist and the patient’s desire to promote female secondary sexual characteristics, she was started on conjugated equine estrogen (Premarin) at 0.3 mg every other day. The importance of following the low-fat diet was reinforced.

Over the next several months, triglyceride levels continued to be elevated, while HDL cholesterol was 20 mg/dl. She was started on gemfibrozil (Lopid) 600 mg twice a day, with lowering of triglyceride levels from 1,800 mg/dl to 772 mg/dl. A year later, leuprolide and conjugated equine . . . [Full Text of this Article]

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				D. Thomas-Dobersen Case Study: A Woman With Type 2 Diabetes and Severe Hypertriglyceridemia Sensitive to Fat Restriction Clin. Diabetes, October 1, 2002; 20(4): 202 - 203. [Full Text] [PDF]