Differential loss of fat in polycystic ovary syndrome: A welcome or warning sign?

Lipodystrophy syndrome is a rare disorder characterized by selective deficiency of adipose tissue and severe insulin resistance resulting in metabolic complications. Its presentation as polycystic ovary disease (PCOD) is even rarer. We present a 23-year-old woman who came with complaints of oligomenorrhoea and hirsutism. When specifically asked, she accepted noticing loss of fat from some areas of her body. Examination showed loss of fat from the face, buttocks and thighs. Her investigations revealed deranged blood sugars, transaminitis, dyslipidaemia and elevated serum testosterone; ultrasonography showed fatty liver and polycystic ovary. Fat composition measurement revealed loss of fat from lower limbs and increased ratio of trunk-to-leg fat. Based on these findings, a diagnosis of lipodystrophy was made. She was started on metformin, statins and ursodeoxycholic acid. Blood sugars, lipid profile and dyslipidaemia improved over a period of 6 months. We suggest that in lean patients with PCOD, lipodystrophy becomes a differential diagnosis, so attention should be paid to body fat distribution in them. Despite normal body mass index (BMI), these patients tend to develop metabolic complications as in our patient (BMI 21.5). This diagnosis has long-term implications in view of its association with metabolic complications.