Differentials
Diabetes
SIGNS / SYMPTOMS
Polyuria, polydipsia, polyphagia, or weight loss may be seen.
Retinopathy, nephropathy, or neuropathy may be present.
INVESTIGATIONS
Elevated fasting blood sugar ≥7 mmol/L (≥126 mg/dL). Additional criteria for diabetes include HbA1c ≥48 mmol/mol (≥6.5%) or abnormal glucose tolerance test results.
Lipodystrophies
SIGNS / SYMPTOMS
Altered fat distribution in genetic or acquired lipodystrophies. Fat atrophy may be partial or generalised. There is underlying insulin resistance and many patients have HTG, occasionally very severe. Hypertension, diabetes, and atherosclerotic cardiovascular disease are often present.
INVESTIGATIONS
Elevated fasting blood sugar ≥7 mmol/L (≥126 mg/dL). Additional criteria for diabetes include HbA1c ≥48 mmol/mol (≥6.5%) or abnormal glucose tolerance test results. Elevated plasma insulin or C-peptide. Positive DNA test will confirm diagnosis of partial or generalised form of lipodystrophy.
Liver disease
SIGNS / SYMPTOMS
With advanced disease, there may be stigmata of chronic liver disease such as spider angiomas or jaundice.
INVESTIGATIONS
Serum transaminases and gamma glutamyl transferase may be elevated. Serum albumin may be low.
Hypothyroidism
SIGNS / SYMPTOMS
Weight gain, sluggishness, dry hair/skin, delayed return of deep tendon reflexes. Goitre may be present in Hashimoto's disease.
INVESTIGATIONS
Thyroid-stimulating hormone is elevated in primary hypothyroidism. In central hypothyroidism there may be laboratory evidence of other pituitary dysfunction.
Renal failure
SIGNS / SYMPTOMS
Malaise, weight loss, fluid retention, hypertension, oedema, pruritus, and breath odour.
INVESTIGATIONS
Elevated urea/creatinine.
HIV infection
SIGNS / SYMPTOMS
Possible acquired lipodystrophy if patient is receiving antiretroviral therapy.
INVESTIGATIONS
HIV serology positive.
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