Adrenergic regulation of lipolysis in a patient with lipoatrophy of the upper body.

A patient with lipoatrophy of the upper body had laboratory evidence of increased activity of the adrenergic nervous system. Because the adrenergic nervous system is important in the regulation of lipolysis, studies were performed to determine whether lipolysis of the upper body was ongoing in this patient and whether pharmacologic reduction of activity of the adrenergic nervous system would affect lipolysis of adipose tissue. Release of free fatty acids from systemic and forearm adipose tissue was measured before and after the administration of guanfacine hydrochloride. Forearm adipose tissue, although decreased in quantity, was found to release normal amounts of free fatty acids. Systemic and forearm release of free fatty acids decreased after 3 days of treatment with guanfacine. These results suggest that lipoatrophy of the upper body in some patients may be mediated through dysfunction of the adrenergic nervous system. These findings also emphasize the potential for heterogeneous responses of adipose tissue to hormonal regulatory factors.