Podcasts

Understanding Lipodystrophy – A Primer for Hepatologists

In this educational video, Dr. Rebecca Brown, pediatric endocrinologist at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), explores the often-overlooked diagnosis of lipodystrophy—an important condition to consider in patients with steatotic liver disease who present with metabolic complications that seem disproportionate to their degree of obesity.

Dr. Brown discusses when to suspect lipodystrophy in patients with MASLD or NAFLD, especially those who are lean but show signs of insulin resistance, diabetes, hypertriglyceridemia, or low HDL. She explains how lipodystrophy leads to ectopic fat deposition due to the absence or loss of functional adipose tissue, how to examine patients for abnormal fat distribution (particularly in gluteofemoral regions), and when to consider genetic testing or specialty referral.

The video also reviews the role of leptin deficiency in the pathophysiology of lipodystrophy, the clinical use of metreleptin in improving metabolic control, and the current evidence around its effect on liver fat, inflammation, and fibrosis. Dr. Brown emphasizes that lipodystrophy is a clinical diagnosis and encourages hepatologists to keep it on their differential when metabolic disease appears out of sync with body habitus.