A Case of Glomerular Lipidosis Accompanied by Familial Combined Hyperlipidemia and Panhypopituitarism.

Abstract

This is a report of a case of glomerular lipidosis with familial combined hyperlipidemia and panhypopituitarism. A 60-yr-old woman was admitted for evaluation of hyponatremia. Admini stration of hydrocortisone normalized the level of serum Na. A pituitary hormone-stimulating test and brain computed tomography revealed panhypopituitarism with an empty sella. Glucocorticoid deficiency due to secondary hypoaldosteronism was thought to have caused the Na loss. She had been treated for thyroid dysfunction and hyperlipidemia with replacement of thyroid hormone and a lipid-lowering drug. Hyperlipidemia changed from type V into IIa in 4yr. Furthermore, one of her brothers and one of her sons were suspected to have type IV hyperlipidemia. Familial combined hyperlipidemia accompanied by secondary hypothyroidism was thought to have increased the levels of both total cholesterol and triglyceride. Two renal biopsies in 3 yr showed lipid deposits in the mesangial cells and indicated a positive correlation between the levels of serum lipids and lipid deposits in glomeruli, which suggested an important role of abnormal lipid metabolism in the progression of glomerular lipidosis. (Internal Medicine 31: 44-49, 1992)

The Effect of Lipoproteins on the Development and Progression of Renal Disease

“…In one case report, familial combined hyperlipidemia with secondary hypothyroidism was associated with lipid deposits in mesangial and endothelial cells; after treatment with lipid-lowering therapy and hormone replacement, the lipid deposits were improved on subsequent renal biopsy [45]. Familial type III hyperlipoproteinemia, characterized by elevated levels of triglycerides and cholesterol, and traditionally associated with systemic manifestations such as xanthomas has rarely been associated with glomerulopathy [37, 46].…”

Review shows that lipid disorders are associated with endothelial but not renal dysfunction in children

“…In adult patients with glomerular disease, foam cells have been associated with interstitial damage and later development of glomerulosclerosis . In a woman with familial combined hyperlipidemia and panhypopituitarism, a renal biopsy showed lipid deposits in the mesangial cells and accumulation of foam cells in the glomeruli .…”

“…Τubular function may also be impaired, and, specifically, dysfunction of the distal convoluted tubule has been reported to be apparent in animals with hypercholesterolaemia, resulting in increased magnesuria and hypomagnesemia, without haemodynamic alterations in the kidney . Information concerning these effects is sparse for adults and even more so for children (Tables and ).…”