Drug-Induced Atypical Lipodystrophy

Abstract

We describe a case of an Asian-Indian female patient who presented to us with abnormal fat accumulations in the torso and upper arms following indiscriminate use of corticosteroid and anabolic steroids for about 7 years. Despite prolonged steroid use, the patient did not display cushingoid phenotype or metabolic decompensation. Bone density, echocardiography, and ultrasonogram of the liver were also normal with no evidence of excess pericardial fat, hepatic steatosis, or peliosis hepatis. Concurrent use of anabolic androgen is thought to be protective against the ill effects of steroids, especially on the muscle and bone. This phenomenon has been observed in children and adolescents with Cushing syndrome where the adrenal androgen excess and increased physical activity have shown to reasonably reduce protein catabolism and help in preserving muscle and bone mass. The patient was withdrawn from the drugs and was put on replacement hydrocortisone that was gradually tapered over the next few weeks and planned for surgical correction. This case highlights the fact that medical providers should be aware that a combination of anabolic steroids and glucocorticoids are still used for weight-building purposes, and these patients may present with atypical signs/symptoms as a result of this combination of drugs.

Keywords: anabolic steroids; atypical lipodystrophy; drug-induced lipodystrophy; steroid abuse; steroid effects.

Figure 1.

The patient is seen to have grade 2 lipedema in both thighs in addition to bilateral multiple symmetrical lipomatosis over the proximal upper arm and abdomen.

Figure 2.

Symmetrical lipomatosis is seen over the back of the trunk.

Figure 3.

A and B depict the fat spread through whole-body dual-energy x-ray absorptiometry scan and the break-up of body composition analysis.