Secondary Causes of Dyslipidemia Flashcards

A patient with glycogen storage disease type I (von Gierke disease) presents with severe hypertriglyceridemia. The primary mechanism is:

Answer: Excess glucose-6-phosphate driving hepatic VLDL overproduction

G6P deficiency causes accumulation of glucose-6-phosphate, which shunts to de novo lipogenesis and massive hepatic VLDL overproduction, causing hypertriglyceridemia.

Anorexia nervosa is associated with which lipid pattern?

Answer: Elevated total cholesterol and LDL-C with reduced bile acid excretion

Anorexia nervosa often paradoxically raises LDL-C and total cholesterol due to reduced bile acid production, decreased LDL receptor activity, and impaired reverse cholesterol transport.

Which medication used for organ transplantation is most likely to worsen dyslipidemia by inhibiting LDL receptor expression?

Answer: Cyclosporine

Cyclosporine inhibits bile acid synthesis and LDL receptor activity, raising LDL-C substantially, and is more atherogenic than tacrolimus.

A patient with alcoholism presents with TG of 1,800 mg/dL. The primary mechanism of alcohol-induced hypertriglyceridemia is:

Answer: Increased hepatic fatty acid synthesis and VLDL secretion with inhibited LPL

Alcohol increases hepatic NADH, promoting de novo fatty acid synthesis and VLDL secretion while inhibiting lipoprotein lipase, dramatically raising triglycerides.

Which renal condition (other than nephrotic syndrome) is associated with significantly elevated Lp(a) levels?

Answer: Chronic kidney disease (non-dialysis)

Chronic kidney disease is associated with reduced hepatic catabolism of Lp(a), leading to elevated Lp(a) levels that may contribute to cardiovascular risk.

Myeloma and paraprotein disorders can cause spurious lipid abnormalities. Which analytical interference is most recognized?

Answer: Cryoglobulins causing false elevation of LDL-C on direct assays

Cryoglobulins and paraproteins in myeloma can precipitate during LDL-C direct assays, causing falsely elevated LDL-C measurements.

In a patient with Cushing's disease successfully treated surgically, which lipid change would be expected post-operatively?

Answer: Reduction in triglycerides and improvement in HDL-C as cortisol normalizes

Surgical correction of hypercortisolism normalizes cortisol-driven insulin resistance, leading to reduced triglycerides and improved HDL-C over weeks to months.