Presentation
To describe an extreme presentation of the chylomicronemia syndrome resulting in multiorgan system dysfunction. [ncbi.nlm.nih.gov]
Presently, the company is conducting an international multi-centre, randomised, double-blind, placebo-controlled Phase three study in patients with Familial Chylomicronemia Syndrome. i) Familial Chylomicronemia Syndrome with either Lipoprotein Lipase [medical-dictionary.thefreedictionary.com]
Immune System
- Splenomegaly
Although the patient had a positive history for recurrent episodes of pancreatitis the characteristic lesions of the hyperchylomicronemia syndrome, such as eruptive xanthomas and lipemia retinalis, were not present and splenomegaly could not be documented [ncbi.nlm.nih.gov]
Hepatomegaly is common, and, if the plasma TG levels are very high, splenomegaly may also be seen. Organomegaly occurs as a result of TG uptake by macrophages, which become foam cells and may rapidly regress with a decrease in dietary fat intake. [clinicaladvisor.com]
Eye fundus examination found lipemia retinalis, and abdominal palpation revealed hepatomegaly with no splenomegaly. [elsevier.es]
Disease, diseased - see also Syndrome Bürger-Grütz E78.3 (essential familial hyperlipemia) chylomicron retention E78.3 Frederickson's hyperlipoproteinemia, type I and V E78.3 Hepatosplenomegaly R16.2 ICD-10-CM Diagnosis Code R16.2 Hepatomegaly with splenomegaly [icd10data.com]
Entire Body System
- Pain
Among all symptoms of FCS, abdominal pain and pancreatitis present the most significant short- and long-term risks to patients. 14-16, 34 Pancreatitis can cause debilitating, life-threatening pain and is often more severe in patients with extremely high [fcs.raredr.com]
Symptoms reported by the patients with FCS were primarily gastrointestinal, including abdominal pain, bloating, constipation, diarrhea and nausea; pain-related, including back pain, referred pain and headache; and fever. [healio.com]
Acute pancreatitis is associated with severe acute upper abdominal pain and elevated serum levels of pancreatic enzymes. [reducetriglycerides.com]
- Fatigue
Abdominal pain and fatigue were the two most commonly reported symptoms. The incidence and frequency of symptoms increased with age, according to most of the patients. [healio.com]
Those living with FCS can be at risk for severe recurrent abdominal pain and potentially fatal pancreatitis, as well as symptoms that can interfere with daily living, including fatigue, lack of energy (asthenia), impaired cognition, and numbness/tingling [fcs.raredr.com]
Over the next 10 years, my symptoms including extreme fatigue, chronic diarrhea, joint pain and chronic headaches continued on a daily basis. [globalgenes.org]
Other signs and symptoms that patients with FCS may experience are: xanthomas (fatty deposits in the skin) lipemia retinalis (milky appearance of retinal veins and arteries) neurological symptoms (such as forgetfulness, fatigue, or/and memory loss) Due [fcsfocus.com]
- Fever
Symptoms reported by the patients with FCS were primarily gastrointestinal, including abdominal pain, bloating, constipation, diarrhea and nausea; pain-related, including back pain, referred pain and headache; and fever. [healio.com]
[…] gist mutations familial aml mutations familial cjd mutations familial amyloid mutations familial dementia mutations familial inherited mutations familial alzheimer's disease mutations ldlr mutations familial hypercholesterolemia familial mediterranean fever [web.shadidphotography.com]
POIKTMP) Familial p olycythaemia vera P rader-Willi Syndrome P rogressive familial intrahepatic cholestasis type 1 P rogressive familial intrahepatic cholestasis type 2 P rogressive familial intrahepatic cholestasis type 3 P rototypic hereditary recurrent fever [gfhev.de]
Rheumatic Fever: Rheumatic fever is an inflammatory reaction that can involve the heart as a consequence of streptococcal infection. Rheumatic Heart Disease: Rheumatic fever can lead to a condition known as rheumatic heart disease. [webmd.com]
Acute respiratory failure, manifesting as pulmonary oedema Coagulopathy, manifesting as abnormal platelet function, as well as proper DIC Headache, fever and jaundice Hepatosplenomegaly These are all good reasons why you should never bolus TPN. [derangedphysiology.com]
- Coronary Atherosclerosis
: Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. [f1000research.com]
- Malaise
[…] ketosisケトーシス、ケトン症 Kussmaul's breathingク[ー]スマウル[大]呼吸〈糖尿病性大呼吸〉 l ligation 結紮 lipolysis脂肪分解 lipoproteinリポ蛋白[質]、リポプロテイン low-density lipoprotein (LDL)低比重リポ蛋白 luteinizing hormone-releasinghormone (LH-RH)LH放出ホルモン m macular edema (ME)黄斑浮腫 malabsorption吸収不良 malaise [tokyo-med.ac.jp]
Respiratoric
- Dyspnea
The chylomicronemia syndrome is associated with marked hypertriglyceridemia (plasma triglyceride level above 2000 mg per dl), abdominal pain or pancreatitis, eruptive xanthomata, lipemia retinalis, dyspnea, mental aberrations, and other minor findings [ncbi.nlm.nih.gov]
However, people with this syndrome, at the onset of symptoms usually have triglyceride elevations greater than 2000 mg/dL, or 22.6 mmol/L and provide a history of recurrent episodes of: abdominal pain, sometimes with nausea vomiting, or dyspnea shortness [reducetriglycerides.com]
Other presenting symptoms may include diarrhea, internal bleeding and dyspnea. LPL deficiency is unlikely to be associated with atherosclerosis but recurrent pancreatitis may be life-threatening. [clinicaladvisor.com]
Recurrent episodes of ill-defined abdominal pain that may be accompanied by nausea and vomiting are the most common presenting symptom, but chest pain and dyspnea may sometimes occur. [emedicine.medscape.com]
Gastrointestinal
- Abdominal Pain
Among all symptoms of FCS, abdominal pain and pancreatitis present the most significant short- and long-term risks to patients. 14-16, 34 Pancreatitis can cause debilitating, life-threatening pain and is often more severe in patients with extremely high [fcs.raredr.com]
Symptoms reported by the patients with FCS were primarily gastrointestinal, including abdominal pain, bloating, constipation, diarrhea and nausea; pain-related, including back pain, referred pain and headache; and fever. [healio.com]
The chylomicronemia syndrome is associated with marked hypertriglyceridemia (plasma triglyceride level above 2000 mg per dl), abdominal pain or pancreatitis, eruptive xanthomata, lipemia retinalis, dyspnea, mental aberrations, and other minor findings [ncbi.nlm.nih.gov]
During the eighteen month treatment period, the patient was essentially symptom free thanks to the gene therapy, experiencing no abdominal pain or pancreatitis attacks. [patientworthy.com]
- Nausea
Symptoms reported by the patients with FCS were primarily gastrointestinal, including abdominal pain, bloating, constipation, diarrhea and nausea; pain-related, including back pain, referred pain and headache; and fever. [healio.com]
[…] significant short- and long-term risks to patients. 14-16, 34 Pancreatitis can cause debilitating, life-threatening pain and is often more severe in patients with extremely high triglyceride levels. 17 Bouts of pancreatitis typically begin with extreme nausea [fcs.raredr.com]
Patients with FCS typically present with multiple symptoms as a result of their extremely high triglyceride levels, including daily or weekly episodes of abdominal pain, nausea and vomiting; neurocognitive effects, such as brain fog, forgetfulness and [ionispharma.com]
[…] particles (chylomicrons) in blood and a corresponding increase of fatty substances called triglycerides The signs and symptoms associated with Familial Lipoprotein Lipase Deficiency include recurrent attacks of pancreatitis resulting in abdominal pain, nausea [dovemed.com]
- Vomiting
[…] short- and long-term risks to patients. 14-16, 34 Pancreatitis can cause debilitating, life-threatening pain and is often more severe in patients with extremely high triglyceride levels. 17 Bouts of pancreatitis typically begin with extreme nausea and vomiting [fcs.raredr.com]
Because of sustained high TG levels, patients with FCS are also at risk of a painful condition called pancreatitis, which is inflammation of the pancreas Patients may also experience vomiting and diarrhea. [fcsfocus.com]
[…] the eyes appear “milky” Memory Loss or ‘foggy-headedness Depression or a sense of isolation Severe pain in the abdomen often including back pain Acute or chronic pancreatitis Xanthomas, fatty deposits in the skin Patients with FCS may also experience: Vomiting [hormone.org]
Patients with FCS typically present with multiple symptoms as a result of their extremely high triglyceride levels, including daily or weekly episodes of abdominal pain, nausea and vomiting; neurocognitive effects, such as brain fog, forgetfulness and [ionispharma.com]
[…] chylomicrons) in blood and a corresponding increase of fatty substances called triglycerides The signs and symptoms associated with Familial Lipoprotein Lipase Deficiency include recurrent attacks of pancreatitis resulting in abdominal pain, nausea, vomiting [dovemed.com]
- Diarrhea
25 Experts Team Up to Reveal How You Can Resolve Your Digestive Issues, Including Gas, Bloating, Constipation, Diarrhea, IBS and More FOR GOOD, So You … Continue reading → [pinterest.es]
Over the next 10 years, my symptoms including extreme fatigue, chronic diarrhea, joint pain and chronic headaches continued on a daily basis. [globalgenes.org]
Because of sustained high TG levels, patients with FCS are also at risk of a painful condition called pancreatitis, which is inflammation of the pancreas Patients may also experience vomiting and diarrhea. [fcsfocus.com]
[…] appear “milky” Memory Loss or ‘foggy-headedness Depression or a sense of isolation Severe pain in the abdomen often including back pain Acute or chronic pancreatitis Xanthomas, fatty deposits in the skin Patients with FCS may also experience: Vomiting or diarrhea [hormone.org]
Symptoms reported by the patients with FCS were primarily gastrointestinal, including abdominal pain, bloating, constipation, diarrhea and nausea; pain-related, including back pain, referred pain and headache; and fever. [healio.com]
Liver, Gall & Pancreas
- Hepatosplenomegaly
Chylomicronemia syndrome (CMS) is a rare disorder characterized by the presence of chylomicrons in the fasting state causing a milky appearance of plasma, eruptive xanthomas, and hepatosplenomegaly; an acute and potentially life threatening complication [ncbi.nlm.nih.gov]
[…] acute recurrent inflammation of the pancreas, which causes debilitating pain and can be fatal. 6-8 Others develop eruptive xanthomas (fatty deposits on the skin) lipemia retinalis (milky appearance of retinal veins and arteries), abdominal pain, and hepatosplenomegaly [fcs.raredr.com]
The impact of FCS includes acute physical manifestations (eruptive xanthoma, lipemia retinalis, hepatosplenomegaly) and potentially life-threatening recurrent acute pancreatitis, which frequently leads to chronic pancreatitis,” Brown and colleagues wrote [healio.com]
R16.2 ICD-10-CM Diagnosis Code R16.2 Hepatomegaly with splenomegaly, not elsewhere classified 2016 2017 2018 2019 Billable/Specific Code Applicable To Hepatosplenomegaly NOS hyperlipemic E78.3 (Bürger-Grütz type) Hyperchylomicronemia (familial) (primary [icd10data.com]
The disease is usually detected in childhood based on repeated episodes of abdominal pain, recurrent attacks of pancreatitis, eruptive cutaneous xanthomatosis, and hepatosplenomegaly. [ommbid.mhmedical.com]
- Hepatomegaly
An abdominal ultrasound examination confirmed hepatomegaly. [elsevier.es]
An enlarged liver (hepatomegaly) is also common. Hepatomegaly is caused by the accumulation of fat in the liver (fatty liver or steatosis). [rarediseases.org]
Hepatomegaly is enlargement of the liver beyond its normal size. [mountsinai.org]
Cardiomegaly Debranching enzyme deficiency Cori disease clinical manifestations Hypotonia, hepatomegaly Shows limit dextrins accumulation Myophosphorilase deficiency Mcardle diseases manifestations - High glycogen in muscle - Muscle cramps - Myoglobinuria [quizlet.com]
Hepatomegaly is common, and, if the plasma TG levels are very high, splenomegaly may also be seen. Organomegaly occurs as a result of TG uptake by macrophages, which become foam cells and may rapidly regress with a decrease in dietary fat intake. [clinicaladvisor.com]
Eyes
- Lipemia Retinalis
The chylomicronemia syndrome is associated with marked hypertriglyceridemia (plasma triglyceride level above 2000 mg per dl), abdominal pain or pancreatitis, eruptive xanthomata, lipemia retinalis, dyspnea, mental aberrations, and other minor findings [ncbi.nlm.nih.gov]
Ophthalmological examination revealed lipemia retinalis. [omicsonline.org]
Skin
- Xanthoma
Abstract A 25-year-old man who presented with eruptive xanthomas, hyperglycemia and hyperlipidemia was admitted to our hospital. [jstage.jst.go.jp]
The xanthomas are the aggregates of chylomicrons that have become large enough to see on the exterior of the skin. [chylomicronemiasyndrome.wordpress.com]
Chylomicronemia, when accompanied by eruptive xanthoma, lipemia retinalis, or abdominal symptoms, is referred to as the "chylomicronemia syndrome" and can cause acute pancreatitis. [ncbi.nlm.nih.gov]
The disease leads to symptoms such as recurrent pancreatitis and fatty deposits in the skin (xanthomas). (See “Symptoms.”) The syndrome results in a marked elevation of chylomicrons and triglycerides. [chylomicronemiasyndrome.com]
- Flushing
[…] side effects of Statins Mechanism: Inhibit HMG CoA reductase Effects: hepatotoxicity and muscle toxicity Major lipid effects of statins Mechanism and side effects of Niacin Mechanism: < fatty acids release, < VLDL synthesis, < HDL clearence Effects: Flushing [quizlet.com]
Psychiatrical
- Withdrawn
The blood is withdrawn from a large vein in the body and passes through a pumping mechanism, and then through a device that puts oxygen into the blood and removes carbon dioxide from the blood. [webmd.com]
- Social Isolation
The role of free fatty acids, pancreatic lipase and Ca2+ signalling in injury of isolated acinar cells and pancreatitis model in lipoprotein lipase-deficient mice. Acta Physiologica 2009; 195: 13-28. [pancreasfoundation.org]
Neurologic
- Confusion
Chronic abdominal pain, mental confusion, and memory loss improved with lipid-lowering therapy and clearing the plasma of chylomicrons. [ncbi.nlm.nih.gov]
It should be noted that the presentation of hyperchylomicronemia may be confused with conditions such as: acute myocardial syndromes and biliary colic - a condition characterized by severe cramping pain in the right upper abdomen due to gallstones in [reducetriglycerides.com]
Ionis was formerly known as Isis Pharamceuticals, which changed its name in December 2015 to avoid any confusion with the Islamic extremist group. Read the related article "Cross-specialty Care in Management of Familial Chylomicronemia Syndrome." [dicardiology.com]
Hyperammonaemia If one has a defective urea cycle, or if one's liver has been damaged by many years of overindulgeance, one may find oneself rather more confused by the administration of a large protein load. [derangedphysiology.com]
- Peripheral Neuropathy
neuropathy - Dermatitis - Anemia - Carboxylation enzymes ex. [quizlet.com]
Workup
A thorough history, physical examination, and laboratory workup failed to identify a clear etiology of the extremely abnormal blood lipid level, prompting genetic investigation to identify the genetic cause of the milky serum. [lipidworld.biomedcentral.com]
See Workup for more detail. [emedicine.medscape.com]
Serum
- Hypertriglyceridemia
The marked hypertriglyceridemia is usually due to the interaction of a common familial form of hypertriglyceridemia and a common acquired form of hypertriglyceridemia secondary to another disease, drug, or alcohol. [ncbi.nlm.nih.gov]
His hypertriglyceridemia had been poorly controlled, because of medication noncompliance. He did not use any medication for his severe hypertriglyceridemia since one year. The patient did not smoke or consume alcohol. [omicsonline.org]
Treatment
The organization will also work to support research targeting new treatments and a cure for FCS. "FCS is a rare genetic disease which can have devastating effects on its victims. [prnewswire.com]
In the study, there were no treatment-related liver adverse events, including no increases in liver fat. There were no treatment-related renal adverse events. [newswire.ca]
After two years of treatment with ciprofibrate, the patient had not experienced new episodes of abdominal pain or new eruptive xanthomas. [elsevier.es]
Prognosis
Affected individuals should talk to their physician and medical team about their specific case, associated symptoms, and overall prognosis. [rarediseases.org]
Therefore, the prognosis of individuals with chylomicronemia syndrome is not so bleak after all. They can lead a relatively normal life, and to be honest, with a healthier diet than many people without the disease. [chylomicronemiasyndrome.wordpress.com]
Outlook (Prognosis) A fat-free diet can reduce symptoms dramatically. Possible Complications When untreated, the excess chylomicrons may lead to bouts of pancreatitis. This condition can be very painful and even life threatening. [ufhealth.org]
Etiology
Abstract Hypertriglyderidemia is responsible for up to 10% of cases of pancreatitis, appearing as the third most common etiology. [galiciaclinica.info]
Other etiologic factors were excluded, including mutations in the PRSS1, SPINK1, and CFTR gene. Although both brothers had recurrent acute pancreatitis and the same LPL genotype, CP became evident in only one patient. [journals.lww.com]
Clinical and biochemical features of different molecular etiologies of familial chylomicronemia. J Clin Lipidol 2018; 12: 920-7. [ Links ] 36. Otokozawa S, Ai M, Diffenderfer M, et al. [scielo.org.ar]
Hegele Hypertriglyceridemia: its etiology, effects and treatment [4] N. Chokshi, S.D. Blumenschein, Z. Ahmad, A. Garg Genotype–phenotype relationships in patients with type I hyperlipoproteinemia [5] T. Gotoda, K. Shirai, T. Ohta, J. Kobayashi, S. [elsevier.es]
In our cases, genetic investigation could help to identify the etiology of infants with milky serum for the heterogeneity of FCS in the young group. [lipidworld.biomedcentral.com]
Epidemiology
[…] treated with it commercially. [7] A total of 31 patients were treated with Glybera, most for free in clinical trials before the drug was taken off the market. [8] Incidence [ edit ] The disorder affects about 1 out of 1,000,000 people; [9] however, epidemiological [en.wikipedia.org]
[…] patients with type 2 diabetes found no effect of combination therapy with fenofibrate and a statin on the primary endpoint of fatal cardiovascular events, nonfatal MI or nonfatal stroke (HR 0.92; 95% CI 0.79-1.08; p=0.32). 40 After reviewing evidence from epidemiological [cmecorner.com]
In epidemiologic and interventional studies, hypertriglyceridemia is a risk factor for coronary artery disease (CAD). [emedicine.medscape.com]
JPN guidelines for the management of acute pancreatitis: Epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13(1):10-24. Kumar J, Wierzbicki AS. Images in clinical medicine. [nanbyou.or.jp]
: Lipoprotein (a): molecular and epidemiologic basis about its role in cardiovascular diseases. Revista Latinoamericana de Hipertensión. 2008; 3 (4): 113–122. Reference Source 46. [f1000research.com]
Pathophysiology
This review discusses the chylomicronemia syndrome presenting the pathophysiologic characteristics of triglyceride and chylomicrons metabolism, diagnosis, prevalence and treatment. [ncbi.nlm.nih.gov]
Purpose/Learning Objectives: Upon successful completion of this educational activity, participants should be better able to: Assess the burden of FCS, its pathophysiology, and the importance of early diagnosis and treatment. [healio.com]
[…] hypercholesterolemia genetic mutations familial hypercholesterolaemia gene mutations familial cancer gene mutations familial frontotemporal dementia mutations familial gastric cancer mutations Lesson on Familial Hypercholesterolemia: Genetic Basis, Pathophysiology [web.shadidphotography.com]
Given the importance of apoC-III in lipid metabolism and its pathophysiological role in CVD and other metabolic disorders, it was an obvious target for therapeutic intervention. [dicardiology.com]
Pathophysiology of hypertriglyceridemia. Biochim Biophys Acta. 2012 May. 1821(5):826-32. [Medline]. [emedicine.medscape.com]
Prevention
Presented at: American Society for Preventive Cardiology Congress on Atherosclerotic Cardiovascular Disease Prevention; Sept. 16-18, 2016; Boca Raton, Fla. [healio.com]
Therapy that successfully lowers plasma triglyceride levels is associated with clearing of the symptoms and signs of the chylomicronemia syndrome and prevention of its recurrence. [ncbi.nlm.nih.gov]
Prevention There is no way to prevent someone from inheriting this syndrome. Images References Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. [ufhealth.org]