Dyslipidemia
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Dyslipidemia is usually asymptomatic. However, it leads to vascular disease that does have symptoms, including coronary artery disease, peripheral artery disease, and stroke. Acute pancreatitis can be caused by high levels of triglycerides (more than 500 mg/dL, equivalent to over 5.65 mmol/L). These high levels also cause confusion, dyspnea, hepatosplenomegaly, and paresthesias. High LDL levels may cause arcus corneae as well as tendinous xanthomas of the Achilles, elbow, and knee tendons, and above the metacarpophalangeal joints (see Figure 8.2). Xanthomas are yellowish in color with surrounding erythematous borders, resulting from increased local extravasation of lipids through the vascular wall to the interstitial spaces of connective tissues. High LDL, as with familial hypercholesterolemia, also causes xanthelasma, which may also develop along with primary biliary cirrhosis even when lipid levels are normal. Xanthelasma usually develops on or around the eyelids in a bilateral and symmetric distribution. The lesions are soft, yellow in color, nontender, and nonpruritic.
Endocrine emergencies with skin manifestations
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Individuals with type 2 diabetes are more likely than those with type 1 diabetes to develop cutaneous manifestations. The skin changes in diabetes are due to metabolic changes, namely, hyperglycemia and hyperlipidemia, and may be a result of progressive damage to vascular, neurologic, or immune systems. Hyperglycemia leads to nonenzymatic glycosylation of various structural and regulatory proteins, including collagen, which in turn causes formation of advanced glycation end products (AGEs). Disorders such as diabetic thick skin and limited joint mobility are thought to result directly from accumulation of AGEs. Certain infections, such as necrotizing soft tissue infections, mucormycosis, pyodermas, and candidiasis, occur more frequently in patients with diabetes. Acanthosis nigricans is due to the action of insulin on the insulin-like growth factor-1 receptor that stimulates epidermal proliferation. The altered lipid metabolism is responsible for hypertriglyceridemia, which manifests as eruptive xanthomas. Nonhealing leg ulcers are due to macro- and microangiopathy and peripheral neuropathy [16].
Atherosclerosis
George Feuer, Felix A. de la Iglesia in Molecular Biochemistry of Human Disease, 2020
In familial dysbetalipoproteinemia or Type III lipoprotein disorder, remnant lipopoteins accumulate in plasma. This is due to substitution of cysteine for arginine in apoE.479 Plasma concentration of cholesterol and triglycerides are increased; the plasma appears turbid. The electrophoretogram shows an elevated β-lipoprotein band extended diffusely into the pre-β-lipoprotein zone. Since apoE is essential for the efficient clearance of chylomicrons and VLDL remnants from the plasma,172 affected individuals have highly elevated levels of these lipoproteins in their bloodstream. The abnormality of the β-lipoprotein band is related to an abnormal triglyceride content many time greater than that found in normal β-lipoproteins. Postheparin lipoprotein lipase activity is low. Xanthomas and other clinical signs of atherosclerosis are present.253 Low cholesterol and unsaturated fatty acid diets are usually advised.
Eruptive xanthoma associated with severe hypertriglyceridemia and poorly controlled type 1 diabetes mellitus
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Sun Yong Lee, Chirag A. Sheth
Xanthomas are disorders of lipoprotein metabolism and formed by an accumulation of cholesterol-rich substance. Several types of xanthomas can be classified based on clinical manifestations. Xanthelasma is the most common form which showed 4.4% in the population with an even distribution between men and women in a recent prospective study [4]. Xanthelasma usually presents on or around the eyelids with bilateral and symmetric distribution and the lesions are soft, yellow, small, nontender, nonpruritic papules around the eyelids. Xanthelasma can occur without hyperlipidemia, particularly in older patients, but is often associated with familial dyslipidemias when seen in a younger patient. Tuberous xanthomas are primarily located over joints and present as firm, painless, red-yellow nodules that often merge into forming multi-lobated tumor-like lesions. They can be associated with severe hypercholesterolemia and elevated LDL levels and some of the secondary hyperlipidemia (e.g. nephrotic syndrome, hypothyroidisom). Tendinous xanthomas are slowly enlarging subcutaneous nodules in association with the tendons or the ligaments. The usual locations include the extensor tendons of the hands, the feet and the Achilles tendons. The tendinous xanthomas associated with severe hypercholesterolemia and elevated LDL levels, particularly in familial hypercholesterolemia [3,4].
Association of tissue inhibitor of metalloproteinase 2 with non-alcoholic fatty liver disease in metabolic syndrome
Published in Archives of Physiology and Biochemistry, 2019
Saira Yasmeen, Unab Khan, Ghulam Mustafa Khan, Syeda Sadia Fatima
Weight and height of subjects were measured in kilograms and metres respectively, using fixed stadiometer (ZT-120 Health scale, made in China). BMI was calculated using the formula weight (kg) divided by height (m2) (kg/m2). WHO Stepwise Approach to Surveillance (STEPS) protocol was used to measure the waist circumference (World Health Organization 2011). The body fat percentage was measured using Diagnostic Scale BG55 by Beurer (Germany) through bioelectrical impedance analysis (BIA). Patients were also examined clinically for the presence of xanthomas (accumulation of lipid foam cells in subcutaneous tissue) or xanthelasma (yellowish fat deposits around/on the eye lid, under the skin). Blood pressure was measured from right upper limb in sitting position using an aneroid sphygmomanometer after the subject was at rest for 5 min.
Periocular amyloid papules as a presenting sign in multiple myeloma
Published in Clinical and Experimental Optometry, 2020
Alexandra Scherk, Alanna Khattar
Melasma, which was the preliminary diagnosis, are flat grey‐brown patches which occur when the melanocytes in the skin produce excess pigment. These lesions can be triggered by sun exposure, changes in hormones or skin care products, none of which were present for the patient in this case. Xanthoma is an accumulation of lipids which usually occur secondary to high cholesterol levels.2016 The patient in this case did not exhibit elevated levels of cholesterol. Papillomas are benign lesions that can present in various shapes, sizes, and colours. These lesions can present in isolation or in multiples, unilaterally or bilaterally. Purpura are small purple spots on the skin which can be signs of platelet disorders, infectious diseases such as human immunodeficiency virus, or amyloidosis.2006 The patient in this case did not present with any purple or bruise‐like lesions. Ultimately, a biopsy was used in this case to determine the aetiology of the eyelid lesion.
Related Knowledge Centers
- Eyelid
- Foam Cell
- Primary Biliary Cholangitis
- Xanthelasma
- Lipid
- Hyperlipidemia
- Cholesterol
- Lipid Storage Disorder
- Sitosterolemia
- Cerebrotendineous Xanthomatosis