DYSREGULATION OF INSULIN-LIKE GROWTH-FACTORS IN A CASE OF GENERALIZEDACQUIRED LIPOATROPHIC DIABETES-MELLITUS (LAWRENCE-SYNDROME) CONNECTEDWITH AUTOANTIBODIES AGAINST ADIPOCYTE MEMBRANES

We report on a 33-year-old male patient with generalized acquired lipo dystrophy, insulin resistant diabetes mellitus and acanthosis nigrican s (Lawrence Syndrome). First probable symptoms of lipodystrophy (weigh t loss, shrinkage of subcutaneous fatty tissue, and loss of muscular s trength) became evident three years ago, with the onset of diabetes me llitus occurring about six months later. The patient suffered from the following clinical symptoms: IDDM with increasing insulin-requirement , extreme reduction of fatty tissue, fatty liver hepatitis with elevat ed liver enzymes, glomerulopathy, muscular and neuropathic pains, as w ell as hypertriglyceridaemia. A basal C-peptide concentration is rathe r high. Definitely, the endogenous insulin secretion is increased. In other words, insulin resistance is documented. In an effort to identif y the pathogenetic mechanisms of lipoatrophic diabetes mellitus in thi s patient and to develop a therapeutic strategy, antibodies against di fferent tissues and endocrinologic regulation were investigated. It wa s possible to demonstrate the presence of serum autoantibodies against lipocytes of the subcutis and other tissues, against hepatic stellate cells, together with autoantibodies against different endocrine organ s. By studying the basis of diabetic abnormalities relating to the gro wth hormone (GH), the insulin-like growth factor (IGF) dynamics in thi s patient, i.e. reductions of GH, IGF-I, IGF-II, IGF-Binding protein ( IGF-BP) 2 and IGF-BP 3, were detected. An immunosuppressive treatment strategy was not beneficial.