INS and renal tubular acidosis: These include alcoholism, HIV,6and other metabolic disturbances, including abnormal glucose tolerance, excessive secretion of insulin, hyperuricemia, renal tubular acidosis, alterations in liver enzyme levels, and abnormal function of the thyroid, adrenal, and pituitary gland, and testicles.8Although the exact pathophysiology has not been identified, it has been proposed that MD is caused by a block in catecholamine-stimulated lipolysis.4