Low dose d-amphetamine induced regression of liver fat deposits in Dercum disease

Clinical Significance
• D-amphetamine anecdotally improves the painful fat/lymphatic disorder, Dercum’s disease.
• Two patients with Dercum’s disease were treated with d-amphetamine to improve lymphatic function through the sympathetic nervous system.
• Both patients lost weight, and fatty liver in a man and liver lipomas in a woman resolved in less than a year on ≤20 mg of D-amphetamine daily.
• Low dose d-amphetamine may improve fatty liver and Dercum’s disease.
Background/Aim
Dercum disease is a rare disorder of painful subcutaneous adipose tissue masses typically presenting as a constellation of signs and symptoms affecting most organs including slow lymphatic flow and fatty liver.
Method
The University of Arizona Institutional Review Board considered this report exempt after patient consent. Multislice, multisequence magnetic resonance imaging (MRI) of the abdomen and pelvis was performed before and after d-amphetamine, with and without intravenous gadolinium.
Results
Initial MRI demonstrated hepatic steatosis in Case 1; Case 2 had two-subcentimeter lipid foci within the liver. Initiation of 10-20 mg d-amphetamine decreased liver lipid deposition from 16% to 4% in Case 1 and resolved fat deposits in Case 2 after ~one year.
Conclusion
There is a dire need for novel treatment options for non-alcoholic fatty liver disease to prevent progression to cirrhosis. Reduction of liver fat by d-amphetamine suggests a potential therapeutic role in non-alcoholic fatty liver disease.

S. Ghazala, J. Bilal, E. Ross, B. Kalb, I.B Riaz, K.L. Herbst

http://www.amjmed.com/article/S0002-9343(18)30015-9/abstract

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