* Examples include diabetes, cholestatic liver disease, renal disease, hypothyroidism, obesity, excessive alcohol consumption, and medications. Our initial laboratory evaluation typically includes fasting glucose, thyroid-stimulating hormone, hemoglobin A1C, liver function, and renal function tests, with test selection influenced by the patient history and review of symptoms. Refer to UpToDate content on secondary causes of dyslipidemia for details.
¶ Refer to UpToDate content on xanthomas for details on associated primary lipid disorders. The approach to evaluation is based upon the lipid profile and suspected primary lipid disorder(s).
Δ In adults without dyslipidemia, a diagnosis of eruptive, tuberous, or tendinous xanthomas should be reconsidered given the strong association of these subtypes with dyslipidemia.
◊ Examples of reported associations include monoclonal gammopathy, multiple myeloma, chronic myelomonocytic leukemia, myelodysplastic syndrome, and lymphoproliferative disorders. Reasonable initial laboratory tests include a complete blood count, serum protein electrophoresis, serum immunofixation, and serum free light chain assay.
§ Whether the presence of plane xanthomas in normolipidemic patients is associated with increased risk for atherosclerotic disease is unclear. Refer to UpToDate content on xanthelasma for details.
¥ Verruciform xanthomas are not associated with hyperlipidemia. The need for additional evaluation is based upon the presence of clinical findings suggestive of other disorders.