Journal of Neurology

, Volume 234, Issue 3, pp 172–176 | Cite as

Spinal epidural lipomatosis: report of a case secondary to hypothyroidism and review of literature

  • P. K. Toshniwal
  • R. P. Glick
Short Communications

Summary

Epidural lipomatosis usually occurs as a complication of steroid therapy. This report includes the first description of a case secondary to hypothyroidism. Adults in all age groups can be affected and present with progressive signs and symptoms of spinal cord or cauda equina compression. The dorsal aspect of the thoracic spine is most commonly involved, usually in its total extent. Spine radiographs are normal and myelography poorly delineates the nature and extent of abnormality. While computed tomography can provide information about the nature of the spinal mass, magnetic resonance imaging is the investigation of choice. Extensive decompressive laminectomy is useful but the results are variable. Correction of underlying endocrine abnormality can reverse the process. The need for early diagnosis of this disorder is therefore emphasized.

Key words

Spinal epidural lipomatosis Hypothyroidism Magnetic resonance imaging 

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References

  1. 1.
    Baquer NZ, Cascales M, McLean P, Greenbaum AL (1976) Effects of thyroid hormone deficiency on the distribution of hepatic metabolites and control of pathways of carbohydrate metabolism in liver and adipose tissue of the rat. Eur J Biochem 68:403–413Google Scholar
  2. 2.
    Bein ME, Mancuso AA, Mink JH, Hansen GC (1978) Computed tomography in the evaluation of mediastinal lipomatosis. J Comput Assist Tomogr 2:379–383Google Scholar
  3. 3.
    Bodman SF, Condemi JJ (1967) Mediastinal widening in iatrogenic Cushing's syndrome. Ann Intern Med 67:399–403Google Scholar
  4. 4.
    Butcher DL, Sahn SA (1979) Epidural lipomatosis: a complication of corticosteroid therapy. Ann Intern Med 90:60Google Scholar
  5. 5.
    Challoner DR (1969) The direct effect of tri-iodothyronine on the oxygen consumption of rat fat cells. Am J Physiol 216:905–909Google Scholar
  6. 6.
    Chapman PH, Martuza RL, Poletti CE, Karchmer AW (1981) Symptomatic spinal epidural lipomatosis associated with Cushing's syndrome. Neurosurgery 8:724–727Google Scholar
  7. 7.
    Clemente DC (ed) (1985) Gray's anatomy. Lea & Febiger, Philadelphia, pp 960–1125Google Scholar
  8. 8.
    Fain JN (1980) Hormonal regulation of lipid mobilization from adipose tissue. In: Litwack G (ed) Biochemical actions of hormones, vol 7. Academic Press, New York, pp 119–204Google Scholar
  9. 9.
    Fain JN (1981) Catecholamine-thyroid hormone interactions in liver and adipose tissue. Life Sci 28:1745–1754Google Scholar
  10. 10.
    Fisher JN, Ball EG (1967) Studies on the metabolism of adipose tissue. XX. The effect of thyroid status upon oxygen consumption and lipolysis. Biochemistry 6:637–647Google Scholar
  11. 11.
    George WE, Wilmot M, Greenhouse A, Hammeke M (1983) Medical management of steroid-induced epidural lipomatosis. N Engl J Med 308:316–319Google Scholar
  12. 12.
    Godeau P, Brunet P, Wechsler B, Fohanno D (1979) Lipomatose extradurale compressive accident inhabituel de la corticotherapie (une observation). Nouv Presse Med 8:3889–3891Google Scholar
  13. 13.
    Goswami A, Rosenberg JN (1978) Thyroid hormone modulation of epinephrine induced lipolysis in rat adipocytes. A possible role of calcium. Endocrinology 103:2223–2233Google Scholar
  14. 14.
    Guegan Y, Fardoun R, Launois B, Pecker J (1982) Spinal cord compression by extradural fat after prolonged corticosteroid therapy. J Neurosurg 56:267–269Google Scholar
  15. 15.
    Hall R, Scanlon MF (1979) Hypothyroidism: clinical features and complications. Clin Endocrinol Metab 8:29–38Google Scholar
  16. 16.
    Klein I, Levey GS (1984) Unusual manifestations of hypothyroidism. Arch Intern Med 144:123–128Google Scholar
  17. 17.
    Koerner HJ, Sun DIC (1966) Mediastinal lipomatosis secondary to steroid therapy. Am J Roentgenol 98:461–464Google Scholar
  18. 18.
    Krishna G, Hynie S, Brodie BB (1968) Effect of thyroid hormone on adenyl cyclase in adipose tissue and free fatty acid mobilization. Proc Natl Acad Sci USA 59:884–889Google Scholar
  19. 19.
    Layzer RB (1985) Endocrine disorders. In: Neuromuscular manifestations of systemic disease. Davis, Philadelphia, pp 79–86Google Scholar
  20. 20.
    Lee M, Lekias J, Gubbay SS, Hurst PE (1975) Spinal cord compression by extradural fat after renal transplantation. Med J Aust 1:201–203Google Scholar
  21. 21.
    Lipson SJ, Naheedy MH, Kaplan MM, Bienfang DC (1980) Spinal stenosis caused by epidural lipomatosis in Cushing's syndrome. N Engl J Med 302:36Google Scholar
  22. 22.
    Lucena GE, Bennett WM, Pierre RV (1966) “Dewlap”. A corticosteroid-induced episternal fatty tumor. N Engl J Med 275:834–835Google Scholar
  23. 23.
    Malbon CC, Graziano WP, Johnson GL (1984) Fat cell β-adrenergic receptor in the hypothyroid rat. Impaired interaction with the stimulating regulatory component of adenylate cyclase. J Biol Chem 259:3254–3260Google Scholar
  24. 24.
    Modic MT, Weinstein MA (1984) Nuclear magnetic resonance of the spine. Br Med Bull 40:183–186Google Scholar
  25. 25.
    Muller MJ, Seitz HJ (1984) Thyroid hormone action on intermediary metabolism. II. Lipid metabolism in hypo- and hyperthyroidism. Klin Wochenschr 62:49–55Google Scholar
  26. 26.
    Norman D, Mills CM, Brant-Zawadzki M, Yeates A, Crooks LE, Kaufman L (1983) Magnetic resonance imaging of the spinal cord and canal: potentials and limitations. Am J Roentgenol 141:1147–1152Google Scholar
  27. 27.
    Price JE Jr, Rigler LG (1970) Widening of the mediastinum resulting from fat accumulation. Radiology 96:497–500Google Scholar
  28. 28.
    Santini LC, Williams JL (1971) Mediastinal widening (presumable lipomatosis) in Cushing's syndrome. N Engl J Med 284:1357–1359Google Scholar
  29. 29.
    Sowerbutts JG (1959) Some uses of presacral oxygen insufflation. J Fac Radiol Lond 20:201–206Google Scholar
  30. 30.
    Watanakunakorn C, Hodges RE, Evans TC (1965) Myxedema: a study of 400 cases. Arch Intern Med 116:183–190Google Scholar
  31. 31.
    Wenker JC, Baker MK, Ellis JH, Glant MD (1984) Focal fatty infiltration of the liver: demonstration by magnetic resonance imaging. Am J Roentgenol 143:573–574Google Scholar
  32. 32.
    Williams AL (1983) CT diagnosis of degenerative disc disease: the bulging annulus. Radiol Clin North Am 21:289–300Google Scholar
  33. 33.
    Young DL, Lynen F (1969) Enzymatic regulation of 3-sn-phos-phatidylcholine and triacylglycerol synthesis in states of altered lipid metabolism. J Biol Chem 244:377–383Google Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • P. K. Toshniwal
    • 1
  • R. P. Glick
    • 1
  1. 1.Divisions of Neurology and NeurosurgeryCook County HospitalChicagoUSA

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