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Roux-en-Y Gastric Bypass Surgery in the management of Familial Partial 2 Lipodystrophy Type 1 (FPLD1)

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Melvin, A 
Flanagan, C 
Gaff, L 
Gratton, B 


Context: Familial partial lipodystrophy type 1 (FPLD1) is an extreme form of central adiposity, with peripheral lipodystrophy associated with severe manifestations of the metabolic syndrome, often poorly responsive to standard therapeutic approaches. Body mass index in FPLD1 varies but, in many cases, is below the level at which metabolic surgery is usually considered as a therapeutic option. Design: We detailed the metabolic response to gastric bypass surgery of three patients with FPLD1, refractory to medical therapy. Results: Roux-en-Y gastric bypass (RYGB) was associated with weight loss and substantial improvements in glycemic control and insulin sensitivity. All three patients were able to stop using insulin. Glucose tolerance testing in one patient demonstrated an increase in L-cell–derived gut hormone responses postoperatively. Conclusion: RYGB surgery substantially improved glycemic control in three patients with FPLD1, two of whom had body mass indices below 30 kg/m². RYGB should be considered in patients with partial lipodystrophy and refractory metabolic disease.



Adult, Anastomosis, Roux-en-Y, Female, Gastric Bypass, Humans, Lipodystrophy, Familial Partial, Middle Aged, Obesity, Morbid

Journal Title

Journal of Clinical Endocrinology and Metabolism

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The Endocrine Society
Wellcome Trust (107064/Z/15/Z)
Evelyn Trust (unknown)
Medical Research Council (MC_UU_12012/5)
Wellcome Trust (095515/Z/11/Z)
Wellcome Trust (098498/Z/12/Z)
Medical Research Council (MC_UU_12012/3)
Medical Research Council (MC_PC_12012)
This work was supported by Wellcome Trust Grants WT106262, WT098498, WT095515, and WT107064 (to F.G., G.R., R.K.S., S.O., and D.B.S.), the Medical Research Council Metabolic Disease Unit, the National Institute for Health Research Cambridge Biomedical Research Centre, and the National Institute for Health Research Rare Disease Translational Research Collaboration.