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(A) Total lipoatrophy of extremities and gluteal area, (B) Two dimensional echocardiography revealed left ventricular hypertrophy (interventricular septum thickness 20 mm), (C) DXA showed increased fat tissue of the abdominal region and decreased fat mass of the upper and lower limbs. Follow-up DXA indicated unchanged total fat mass content, (D) The abdominal MRI image shows hepatic steatosis.
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Blood pressure was 175/84 mmHg.She was underweighted with a BMI: 19.40 kg/m2 (weight: 46 kg, height: 154 cm) ( Figure 1A ). Abdominal Magnetic Resonance Imaging (MRI) was unremarkable apart from hepatomegaly with a liver percentage fat fraction of 9.4%, and an enlarged spleen ( Figure 1D ). Two-dimensional echocardiography revealed severe left ventricular hypertrophy, minimal mitral regurgitation, and ejection fraction of 60% ( Figure 1B ). A repeated DXA scan showed unchanged total fat mass content and cardiac MRI revealed no change ( Figure 1C ).
Changes in (A) HbA1C and (B) triglycerides during metreleptin treatment. HbA1C, Glycated hemoglobin.
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TG (198 mg/dl). This improvement was sustained one year after treatment with metreleptin in the same dose (HbA1C: 8%, TG: 185 mg/dl-standard serum determinations are listed in  Table 2 ), ( Figures 2A, B ).