Successful treatment of severe hypertriglyceridemia with icosapent ethyl in a case of congenital generalized lipodystrophy type 4

Authors

Funmbi Babalola, Hospital for Sick Children University of TorontoFollow
Dominic Ng, Saint Michael's Hospital University of Toronto
Anica Bulic, Hospital for Sick Children University of Toronto
Jacqueline Curtis, Hospital for Sick Children University of Toronto

Document Type

Article

Publication Date

1-1-2022

Journal

Journal of Pediatric Endocrinology and Metabolism

URL with Digital Object Identifier

10.1515/jpem-2021-0718

Abstract

Congenital generalized lipodystrophy type 4 (CGL4) is a rare autosomal recessive condition with high rates of morbidity and mortality. It is a multisystem condition associated with ventricular tachyarrhythmia, congenital myopathy, hepatitis, and metabolic profile of severe hypertriglyceridemia and insulin resistance. Metreleptin is the first line treatment, however it is unavailable in several countries. Herein, we describe a unique presentation and treatment of CGL4. A 16-year-old female presented with insulin resistant diabetes, and was later found to have myopathy, hypertriglyceridemia, nonalcoholic fatty liver disease, ventricular arrhythmias, and genetic confirmation of CGL4 due to homozygous change in CAVIN1 gene. She had severe hypertriglyceridemia, frequently >17 mmol/L, requiring several hospital admissions. To better control hypertriglyceridemia, in context of known congenital myopathy, we opted for treatment with icosapent ethyl, an ethyl ester of eicosapentaenoic acid (EPA), which reduces synthesis and enhances clearance of triglycerides. On this treatment, she was able to maintain stable triglyceride levels of 4 mmol/L. We present the first case report of a patient with CGL4, successfully treated for hypertriglyceridemia, with icosapent ethyl.