Unmasking a case of sitosterolaemia: an approach for diagnosis and management
  • Mostafa Elbanna
    Department of Medicine, Unity Hospital, Rochester Regional Health, Rochester, USA
  • Fahad Eid
    Department of Medicine, Unity Hospital, Rochester Regional Health, Rochester, USA
  • Mostafa Zaalouk
    Department of Medicine, Unity Hospital, Rochester Regional Health, Rochester, USA
  • Ahmad Nawid Latifi
    Department of Cardiovascular Diseases, RGH, Rochester Regional Health, Rochester, USA
  • Gaurav Sharma
    Department of Cardiovascular Diseases, RGH, Rochester Regional Health, Rochester, USA

Keywords

Dyslipidaemia, sitosterolaemia, ezetimibe, evolocumab

Abstract

This report presents a 57-year-old female with a history of dyslipidaemia, intolerant to statins and currently managed on evolocumab. Despite a healthy lifestyle, lipid panel abnormalities persisted, leading to an investigation that revealed heterozygous mutations in the ABCG8 gene, confirming a diagnosis of sitosterolaemia. The patient’s unique response to lipid-lowering medications typified this rare disorder, necessitating specialised genetic testing for diagnosis. Management involved dietary modifications and the introduction of ezetimibe, evolocumab and atorvastatin, demonstrating the personalised nature of treatment. The case underscores the importance of considering sitosterolaemia in unexplained lipid abnormalities and highlights the challenges in diagnosis and management. Ongoing research is crucial for refining diagnostic and therapeutic strategies for this clinically significant disorder, emphasising the need for a multidisciplinary approach to patient care.

VIEW THE ENTIRE ARTICLE

References

  • Kiss S, Lee JY, Pitt J, MacGregor D, Wallace J, Marty M, et al. Dig deeper when it does not make sense: juvenile xanthomas due to sitosterolemia. JIMD Rep 2020;56:34–39.
  • Salen G, von Bergmann K, Lütjohann D, Kwiterovich P, Kane J, Patel SB, et al. Ezetimibe effectively reduces plasma plant sterols in patients with sitosterolemia. Circulation 2004;109:966–971.
  • Othman RA, Myrie SB, Mymin D, Merkens LS, Roullet JB, Steiner RD, et al. Ezetimibe reduces plant sterol accumulation and favorably increases platelet count in sitosterolemia. J Pediatr 2015;166:125–131.
  • Brown EE, Sturm AC, Cuchel M, Braun LT, Duell PB, Underberg JA, et al. Genetic testing in dyslipidemia: a scientific statement from the National Lipid Association. J Clin Lipidol 2020;14:398–413.
  • Lütjohann D, von Bergmann K, Sirah W, Macdonell G, Johnson-Levonas AO, Shah A, et al. Long-term efficacy and safety of ezetimibe 10 mg in patients with homozygous sitosterolemia: a 2-year, open-label extension study. Int J Clin Pract 2008;62:1499–1510.
  • Kojima N, Tada H, Usui S, Sakata K, Hayashi K, Nohara A, et al. Serum sitosterol level predicting ABCG5 or ABCG8 genetic mutations. Clin Chim Acta 2020;507:11–16.
  • Kratz M, Kannenberg F, Gramenz E, Berning B, Trautwein E, Assmann G, et al. Similar serum plant sterol responses of human subjects heterozygous for a mutation causing sitosterolemia and controls to diets enriched in plant sterols or stanols. Eur J Clin Nutr 2007;61:896–905.
  • Salen G, Shefer S, Nguyen L, Ness GC, Tint GS, Shore V. Sitosterolemia. J Lipid Res 1992;33:945–955.
  • Tada H, Nohara A, Inazu A, Sakuma N, Mabuchi H, Kawashiri MA. Sitosterolemia, hypercholesterolemia, and coronary artery disease. J Atheroscler Thromb 2018;25:783–789.
  • Views: 63
    HTML downloads: 11
    PDF downloads: 47


    Published: 2024-05-31
    Issue: 2024: LATEST ONLINE (view)


    How to cite:
    1.
    Elbanna M, Eid F, Zaalouk M, Latifi AN, Sharma G. Unmasking a case of sitosterolaemia: an approach for diagnosis and management. EJCRIM 2024;11 doi:10.12890/2024_004541.