CC BY-NC-ND 4.0 · Dtsch Med Wochenschr 2023; 148(23): e120-e146
DOI: 10.1055/a-1516-2511

Labordiagnostik von Fettstoffwechselstörungen

Laboratory diagnostics of lipid metabolism disorders
Winfried März
Hubert Scharnagl
Marcus Kleber
Günther Silbernagel
Matthias Nauck
Dirk Müller-Wieland
Arnold von Eckardstein

Fettstoffwechselstörungen zeigen häufig keine klinischen Symptome, einzig Hauterscheinungen können auf einen gestörten Fettstoffwechsel hinweisen. Daher sind weitreichende Laboruntersuchungen für die Diagnostik ausschlaggebend. Dieser Artikel zeigt die basisdiagnostischen Möglichkeiten zur Verifizierung einer Fettstoffwechselstörung auf, befasst sich mit ergänzenden Laboruntersuchungen und nennt therapeutische Zielgrößen.


Clinically, disorders of lipid metabolism often remain without symptoms. Typical skin lesions, however, can be indicative. Secondary hyperlipoproteinemias (HLP) are more common than primary hyperlipoproteinemias; they can (partially) be improved by treating the underlying disease. Basic diagnostics consist of the determination of cholesterol, triglycerides, LDL cholesterol and HDL cholesterol. To exclude secondary HLP, glucose, HbA1C, TSH, transaminases, creatinine, urea, protein and protein in the urine are useful. Since virtually all routine methods for LDL-C are biased by high triglycerides, lipoprotein electrophoresis is indicated for triglycerides above 400 mg/dl (4.7 mmol/l). Primary HLPs have known or yet unknown genetic causes. Primary hyperlipidemias should be taken into consideration especially in young patients with an LDL cholesterol concentration are above 190 mg/dl (4.9 mmol/l) and/or triglycerides above 400 mg/dl (10 mmol/l) and secondary HLP (obesity, alcohol, diabetes mellitus, kidney disease) is excluded. The basic diagnostics is meaningfully extended by the measurement of lipoprotein (a) (Lp(a)). It is indicated in moderate and high risk of vascular disease, progression of atherosclerosis in "well-controlled" LDL cholesterol, familial clustering of atherosclerosis or high Lp(a), evidence for elevated Lp(a) coming from lipoprotein electrophoresis, aortic stenosis and in patients in whom statins have a poor effect. Genetic diagnostics needs to be considered if primary HLP is suspected. It is most frequently conducted for suspected familial hypercholesterolemia and has already been recommended in guidelines.

Publication History

Article published online:
10 November 2023

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