Fig. 1

Patient pictures showing generalized fat loss. a: Near-total lack of adipose tissue and muscular appearance in the trunk. Arms are very muscular. Note that there is no fat accumulation in the neck. In contrast, subcutaneous fat is lost over shoulders and in the upper trunk. b: Subcutaneous fat is lost in the abdomen. Muscular appearance is remarkable. c: Arms are muscular with visible vessels and no subcutaneous fat. d: Subcutaneous fat is lost in the distal legs. Legs are muscular with prominent veins. e: Acanthosis nigricans and skin tags in the armpits associated with severe insulin resistance