Partial Lipodystrophy

Familial Partial Lipodystrophy (FPLD) is a metabolic disorder characterized by abnormal subcutaneous adipose tissue distribution beginning in late childhood or early adult life. Affected individuals gradually lose fat from the upper and lower extremities and the gluteal and truncal regions, resulting in a muscular appearance with prominent superficial veins. In some patients, adipose tissue accumulates on the face and neck, causing a double chin, fat neck, or cushingoid appearance. Metabolic abnormalities include insulin-resistant diabetes mellitus with acanthosis nigricans and hypertriglyceridemia; hirsutism and menstrual abnormalities occur infrequently.

FPLD is a clinically and genetically heterogeneous disorder, caused by variants in the LMNA, PPARG and PLIN1 genes (Shackleton et al 2000 Nat Genet 24: 153-158, Barroso et al 1999 Nature 402: 880-883, Gandotra et al 2011 N Engl J Med 364: 740-748). LMNA gene variants are the most common cause of FPLD, and missense variants of the arginine residue at codon 482 of LMNA account for 90% of FPLD type 2 families.  Disease-causing LMNA variants not at position p.R482 are associated with severe metabolic alterations (metabolic laminopathy) but with clinically less obvious lipodystrophy (Decaudain et al 2007 J Clin Enodcrinol Metab 92: 4835-4844; Dutour et al 2011 Hum Mol Genet 20: 3779-3786).

LMNA, PPARG and PLIN1 gene analysis in familial partial lipodystrophy.

Visit the NHS Genomic Test Directory 

Eligibility criteria for genomic tests can be found in the National Genomic Test Directory.

This lists the clinical specialties that would be expected to request for a given clinical indication and sets out which patients should be considered for testing.

All samples for genomic testing should be accompanied by a fully completed request form.

The request form should include as much clinical information about the patient or family member, family relationships and the requested test code (R number). All request forms must indicate either a specific disorder/gene(s) to be investigated or, a request to extract and store DNA.

This form should be used for the majority of test requests.

Please do not download and store this on your desktop or system. The form is regularly updated. Our recommendation is to save or bookmark a link to our website to ensure you are working with the most up-do-date version.

Download the latest version here: GMS Test Order Form v2.3

An appropriate discussion of genomic testing and the possible implications for a patient and their family members must take place before testing is requested.

It is the referring clinician’s responsibility to ensure that the patient/carer knows the purpose of the test and that the sample may be stored for future diagnostic testing. In submitting a sample with a request form, the clinician confirms that informed consent has been obtained for (a) testing and storage (indefinitely) (b) the use of this sample and the information generated from it to be shared with members of the donor’s family and their health professionals (if appropriate). The patient should be advised that the samples may be used anonymously for quality assurance and training purposes.

If stated as a requirement for a specific test, a record of this discussion must be retained within the patient record when a genomic test is ordered.

For more information please view the Consent and Confidentiality in Genomic Medicine guidelines from the Joint Committee on Medical Genetics.

Before sending samples for genomic testing, please ensure you follow the correct preparation and transport guidelines. This includes information on sample types, volumes, handling, labelling, and packaging standards.

For a full list of sample requirements and transport guidance, please visit the samples and transport page of the website. 

Turnaround times (TATs) for genomic tests are continually refined through ongoing reviews of testing standards.

Results will be returned to the email account or clinician listed on the request form.

Visit the results and turnaround page for more information.

Information on the National Severe Insulin Resistance Service which provides investigation and management services for this and associated conditions at Addenbrooke’s Hospital (Cambridge) is available from the following link:

Severe Insulin Resistance Service