A case of hypocholesterolemia under study

Clin Investig Arterioscler. 2023 Sep-Oct;35(5):244-247. doi: 10.1016/j.arteri.2023.05.003. Epub 2023 Jun 9.
[Article in English, Spanish]


Primary hypocholesterolemia (or hypobetalipoproteinemia) is a rare disorder of lipoprotein metabolism that may be due to a polygenic predisposition or a monogenic disease. Among these, it is possible to differentiate between symptomatic and asymptomatic forms, in which, in the absence of secondary causes, the initial clinical suspicion is plasma ApoB levels below the 5th percentile of the distribution by age and sex. Here we describe the differential diagnosis of a case of asymptomatic hypocholesterolemia. We studied proband's clinical data, the lipid profile of the proband and her relatives and the clinical data of the family relevant to carry out the differential diagnosis. We performed a genetic study as the diagnostic test. The information obtained from the differential diagnosis suggested a heterozygous hypobetalipoproteinemia due to PCSK9 loss-of-function variants. The diagnostic test revealed, in the proband, the presence of a heterozygous PCSK9 frame-shift variant of a maternal origin. Plasma levels of LDL cholesterol and PCSK9 of the patient and her relatives were compatible with the segregation of the variant revealed. In conclusion, the diagnostic test performed confirmed the suspected diagnosis of the proband as asymptomatic familial hypobetalipoproteinemia due to a loss-of-function variant in the PCSK9 gene.

Keywords: Apolipoprotein B; Apolipoproteína B; Asymptomatic hypobetalipoproteinemia; Diagnostic test; Hipobetalipoproteinemia asintomática; Hipocolesterolemia primaria; Loss of function variant; PCSK9; Primary hypocholesterolemia; Prueba diagnóstica; Variante de pérdida de función.

Publication types

  • Case Reports

MeSH terms

  • Apolipoproteins B
  • Cholesterol, LDL
  • Female
  • Humans
  • Hypobetalipoproteinemias* / diagnosis
  • Hypobetalipoproteinemias* / genetics
  • Hypolipoproteinemias*
  • Proprotein Convertase 9 / genetics


  • PCSK9 protein, human
  • Proprotein Convertase 9
  • Cholesterol, LDL
  • Apolipoproteins B