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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the comments received following the publication of our case report on late-onset acquired generalized lipodystrophy with muscle involvement in <span class="elsevierStyleItalic">Actas Dermo-Sifiliogr&#225;ficas</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and would like to add the following clarifications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Subclinical hypothyroidism affects up to 20&#37; of women aged over 65 years&#44; and appears to have little influence on muscle mass or quality in this subgroup of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There have&#44; however&#44; been isolated reports of polymyositis in patients with hypothyroidism&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In such cases&#44; there tend to be signs and symptoms of neuromuscular involvement&#44; with biopsy showing inflammatory muscle infiltrates or signs of atrophy&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Furthermore&#44; Duyff et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported increased creatine kinase &#40;CK&#41; levels in a group of hypothyroid patients &#40;n<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>24&#41;&#44; but observed no association with thyroid-stimulating hormone &#40;TSH&#41; or free thyroxine &#40;T4&#41; levels or with muscle signs and symptoms&#46; The authors also reported that these patients may show both neuropathic &#40;24&#37;&#41; and myopathic &#40;10&#37;&#41; electrodiagnostic changes&#46; Our patient was diagnosed with subclinical hypothyroidism in August 2008&#46; The condition was successfully controlled with oral levothyroxine 25<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#44; with normalization of TSH levels&#46; Regarding the possible relationship between the increased CK levels in our patient and the use of fibrates to treat hypertriglyceridemia&#44; it should be noted that these levels had been elevated since 2005&#44; when treatment was started with gemfibrozil &#40;replaced by fenofibrate in 2008&#41;&#46; Rhabdomyolysis due to fibrates typically presents between 36<span class="elsevierStyleHsp" style=""></span>hours and 6 months after ingestion of the drug&#44; is most often caused by gemfibrozil&#44; and can result in acute renal failure&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Fortunately&#44; there are few such cases&#44; but slight elevations in CK are not uncommon in patients on gemfibrozil&#44; especially when it is used in combination with statin therapy&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We cannot&#44; therefore&#44; rule out the possibility that fibrate therapy might have contributed to our patient&#39;s persistently elevated CK levels&#46; However&#44; numerous factors suggest that these were more likely to have been related to her general condition&#44; namely&#44; the absence of signs or symptoms of muscle involvement or clinical weakness&#44; the persistent elevation in CK levels despite the change in fibrate therapy and its temporary suspension&#44; and finally the detection of myopathic changes by electromyography&#46;</p></span>"
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Letter to the Editor
Response to Comments on “Late-Onset Acquired Generalized Lipodystrophy With Muscle Involvement”
Réplica a: «Lipodistrofia generalizada adquirida de inicio tardío y con afectación muscular»
M. Llamas-Velascoa,
Corresponding author
mar.llamasvelasco@gmail.com

Corresponding author.
, E. Daudéna, G. Martínez-Peñasb, A. García-Dieza
a Departamento de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain
b Departamento de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the comments received following the publication of our case report on late-onset acquired generalized lipodystrophy with muscle involvement in <span class="elsevierStyleItalic">Actas Dermo-Sifiliogr&#225;ficas</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and would like to add the following clarifications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Subclinical hypothyroidism affects up to 20&#37; of women aged over 65 years&#44; and appears to have little influence on muscle mass or quality in this subgroup of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There have&#44; however&#44; been isolated reports of polymyositis in patients with hypothyroidism&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In such cases&#44; there tend to be signs and symptoms of neuromuscular involvement&#44; with biopsy showing inflammatory muscle infiltrates or signs of atrophy&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Furthermore&#44; Duyff et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported increased creatine kinase &#40;CK&#41; levels in a group of hypothyroid patients &#40;n<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>24&#41;&#44; but observed no association with thyroid-stimulating hormone &#40;TSH&#41; or free thyroxine &#40;T4&#41; levels or with muscle signs and symptoms&#46; The authors also reported that these patients may show both neuropathic &#40;24&#37;&#41; and myopathic &#40;10&#37;&#41; electrodiagnostic changes&#46; Our patient was diagnosed with subclinical hypothyroidism in August 2008&#46; The condition was successfully controlled with oral levothyroxine 25<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#44; with normalization of TSH levels&#46; Regarding the possible relationship between the increased CK levels in our patient and the use of fibrates to treat hypertriglyceridemia&#44; it should be noted that these levels had been elevated since 2005&#44; when treatment was started with gemfibrozil &#40;replaced by fenofibrate in 2008&#41;&#46; Rhabdomyolysis due to fibrates typically presents between 36<span class="elsevierStyleHsp" style=""></span>hours and 6 months after ingestion of the drug&#44; is most often caused by gemfibrozil&#44; and can result in acute renal failure&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Fortunately&#44; there are few such cases&#44; but slight elevations in CK are not uncommon in patients on gemfibrozil&#44; especially when it is used in combination with statin therapy&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We cannot&#44; therefore&#44; rule out the possibility that fibrate therapy might have contributed to our patient&#39;s persistently elevated CK levels&#46; However&#44; numerous factors suggest that these were more likely to have been related to her general condition&#44; namely&#44; the absence of signs or symptoms of muscle involvement or clinical weakness&#44; the persistent elevation in CK levels despite the change in fibrate therapy and its temporary suspension&#44; and finally the detection of myopathic changes by electromyography&#46;</p></span>"
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Idiomas
Actas Dermo-Sifiliográficas
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