Lipoprotein disorders causes

Lipoprotein Disorders Microchapters
Patient Information
Overview
Causes
Classification Hyperlipoproteinemia Hypolipoproteinemia
Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D.

Overview

Hyperlipidemia can occur as either a primary event or secondary to some underlying disease. The primary hyperlipidemias include chylomicronemia, hypercholesterolemia, dysbetalipoproteinemia, hypertriglyceridemia, mixed hyperlipoproteinemia, and combined hyperlipoproteinemia. Other diseases, such as diabetes mellitus, pancreatitis, renal disease, and hypothyroidism, can cause the secondary form.

Causes

Primary Hyperlipidemia

Hyperlipoproteinemia type I

• Deficiency of lipoprotein lipase (LPL) or altered apolipoprotein C2

Hyperlipoproteinemia type II

Type IIa

• Familial hypercholesterolemia
  • Sporadic (due to dietary factors)
  • Polygenic (multiple abnormalities in LDL metabolism)
  • Truly familial (as a result of a mutation in the LDL receptor gene on chromosome 19 (0.2% of the population), the apo B gene (0.2%) or the proprotein convertase subtilisin kexin 9 (PCSK9) gene (very rare))

Type IIb

• Familial combined hyperlipoproteinemia (FCH)
  • Overproduction of hepatically-derived apo B-100 associated with VLDL
  • Overproduction of substrates, including triglycerides and acetyl-CoA
  • Decreased clearance of LDL

Hyperlipoproteinemia type III

• Presence of apo E E2/E2 genotype resulting in cholesterol-rich VLDL (β-VLDL)

Hyperlipoproteinemia type IV

• Familial hypertriglyceridemia
  • Genetic defect, which is passed on in an autosomal dominant fashion

Hyperlipoproteinemia type V

• Very similar to type I, but with high VLDL in addition to chylomicrons
• Associated with glucose intolerance and hyperuricemia

Familial lecithin-cholesterol acyltransferase (LCAT) deficiency

• Caused by mutations of the LCAT gene located on chromosome 16q22, which is passed on in an autosomal recessive fashion
• Associated with corneal opacities, hemolytic anaemia, and proteinuria

Secondary Hyperlipidemia

Secondary to some underlying "non-lipid" etiology

• Acromegaly
• Alcohol
• Chronic renal failure
• Cholestatic liver diseases
• Cushing's syndrome
• Connective tissue disorders
  • Dysglobulinemias (lupus, lymphoma, myeloma, Waldenström's macroglobulinemia)
  • Glycogen storage disease, type I
• Diabetes mellitus, type 2
• Hypothyroidism
• Hypopituitarism (ateliotic dwarfism)
• Lipodystrophy (congenital or acquired)
• Nephrotic syndrome
• Obesity
• Pancreatitis
• Pregnancy
• Sepsis
• Stress
• Smoking
• Drugs
  • Oral estrogens
  • Thiazide diuretics
  • Beta blockers
  • Atypical antipsychotic agents, such as clozapine and olanzapine
  • Antiretroviral drugs used for HIV infection, in particular the protease inhibitors
  • Bile acid binding resins
  • Cimetidine
  • Glucocorticoids
  • Isotretinoin

Causes by Organ System

Cardiovascular	Alagille syndrome
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Amprenavir, Atazanavir sulfate, Atypical antipsychotics, Bendrofluazide, Beta blockers, Bexarotene, Chenodeoxycholic acid, Chlorthalidone, Clofibrate, Colesevelam hydrochloride, Colestyramine, Combined oral contraceptive pill, Cyclopenthiazide, Danazol, Desvenlafaxine, Doxazosin, Ethanol, Etretinate, Fosamprenavir, Gestrinone, Hydrochlorothiazide, Interferon alpha, Isotretinoin, Linagliptin, Lopinavir, Mitotane, Nelfinavir, Prazosin, Progestagens, Propofol, Protease inhibitors, Ritonavir, Rosiglitazone, Saquinavir, Sirolimus, Temsirolimus, Testosterone, Thiazide diuretics, Tipranavir, Tocilizumab, Tofacitinib, Torcetrapib
Ear Nose Throat	No underlying causes
Endocrine	Cushing syndrome, Diabetes mellitus type 2, Hypothyroidism, Metabolic syndrome, Hypopituitarism
Environmental	No underlying causes
Gastroenterologic	Cholestatic jaundice, Intrahepatic cholestasis, Malignant hepatopathy, Pancreatitis, Alagille syndrome
Genetic	Alagille syndrome, Alstrom syndrome, Analbuminaemia, Apolipoprotein C-II deficiency, Apoprotein E deficiency, Berardinelli-Seip congenital lipodystrophy, Carnitine palmitoyltransferase 1 deficiency, Chromosome 15q deletion, Familial alphalipoprotein deficiency, Familial defective apolipoprotein B-100, Familial hypertriglyceridaemia, Familial isolated vitamin E deficiency, Familial mixed hyperlipidemia, Fructose-1, 6-diphosphatase deficiency, Glycogen storage diseases, Lecithin cholesterol acyltransferase deficiency, Lipoprotein lipase deficiency, Niemann-Pick disease , Primary hyperlipoproteinemia , Primary hypolipoproteinemia, Smith-Lemli-Opitz syndrome, Werner syndrome
Hematologic	No underlying causes
Iatrogenic	Parenteral nutrition
Infectious Disease	Sepsis
Musculoskeletal / Ortho	Smith-Lemli-Opitz syndrome
Neurologic	Growth hormone secreting pituitary adenoma
Nutritional / Metabolic	Dysglobulinemia, LDL receptor deficiency, Omega-3 polyunsaturated fatty acids, Selenium deficiency, Vitamin E deficiency, Smith-Lemli-Opitz syndrome, Apolipoprotein C-II deficiency, Apoprotein E deficiency, Carnitine palmitoyltransferase 1 deficiency, Familial isolated vitamin E deficiency, Fructose-1, 6-diphosphatase deficiency, Glycogen storage diseases, Lecithin cholesterol acyltransferase deficiency, Lipoprotein lipase deficiency, Niemann-Pick disease , Primary hypolipoproteinemia
Obstetric/Gynecologic	Pregnancy
Oncologic	Growth hormone secreting pituitary adenoma
Opthalmologic	No underlying causes
Overdose / Toxicity	Amprenavir, Atazanavir sulfate, Atypical antipsychotics, Bendrofluazide, Beta blockers, Bexarotene, Chenodeoxycholic acid, Chlorthalidone, Clofibrate, Colesevelam hydrochloride, Colestyramine, Combined oral contraceptive pill, Cyclopenthiazide, Danazol, Desvenlafaxine, Doxazosin, Ethanol, Etretinate, Fosamprenavir, Gestrinone, Hydrochlorothiazide, Interferon alpha, Isotretinoin, Linagliptin, Lopinavir, Mitotane, Nelfinavir, Prazosin, Progestagens, Propofol, Protease inhibitors, Ritonavir, Rosiglitazone, Saquinavir, Sirolimus, Temsirolimus, Testosterone, Thiazide diuretics, Tipranavir, Tocilizumab, Tofacitinib, Torcetrapib
Psychiatric	Anorexia nervosa
Pulmonary	No underlying causes
Renal / Electrolyte	Chronic renal failure, Nephrotic syndrome, Alagille syndrome
Rheum / Immune / Allergy	Macrophage activation syndrome
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcohol abuse, Benign symmetrical lipomatosis, Exercise, Hight fat diet, Obesity, Positive family history, Sedentary lifestyle , Stress, Tobacco smoking

Causes in Alphabetical Order

Alagille syndrome Alcohol abuse Alstrom syndrome Amprenavir Analbuminaemia Anorexia nervosa Apolipoprotein C-II deficiency Apoprotein E deficiency Atazanavir sulfate Atypical antipsychotics Bendrofluazide Benign symmetrical lipomatosis Berardinelli-Seip congenital lipodystrophy Beta blockers Bexarotene Carnitine palmitoyltransferase 1 deficiency Chenodeoxycholic acid Chlorthalidone Cholestatic jaundice Chromosome 15q deletion Chronic renal failure Clofibrate Colesevelam hydrochloride Colestyramine Combined oral contraceptive pill Cushing syndrome Cyclopenthiazide Danazol Desvenlafaxine Diabetes mellitus type 2 Doxazosin Dysglobulinemia Ethanol Etretinate Exercise Familial alphalipoprotein deficiency Familial defective apolipoprotein B-100 Familial hypertriglyceridaemia Familial isolated vitamin E deficiency Familial mixed hyperlipidemia Fosamprenavir Fructose-1, 6-diphosphatase deficiency Gestrinone Glycogen storage diseases Growth hormone secreting pituitary adenoma Hight fat diet Hydrochlorothiazide

Hypopituitarism Hypothyroidism Interferon alpha Intrahepatic cholestasis Isotretinoin LDL receptor deficiency Lecithin cholesterol acyltransferase deficiency Linagliptin Lipoprotein lipase deficiency Lopinavir Macrophage activation syndrome Malignant hepatopathy Metabolic syndrome Mitotane Nelfinavir Nephrotic syndrome Niemann-Pick disease Obesity Omega-3 polyunsaturated fatty acids Pancreatitis Parenteral nutrition Positive family history Prazosin Pregnancy Primary hyperlipoproteinemia Primary hypolipoproteinemia Progestagens Propofol Protease inhibitors Ritonavir Rosiglitazone Saquinavir Sedentary lifestyle Selenium deficiency Sepsis Sirolimus Smith-Lemli-Opitz syndrome Stress Temsirolimus Testosterone Thiazide diuretics Tipranavir Tobacco smoking Tocilizumab Tofacitinib Torcetrapib Vitamin E deficiency Werner syndrome

References

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