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

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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.

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References

  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 68:403–413

    Google Scholar 

  2. Bein ME, Mancuso AA, Mink JH, Hansen GC (1978) Computed tomography in the evaluation of mediastinal lipomatosis. J Comput Assist Tomogr 2:379–383

    Google Scholar 

  3. Bodman SF, Condemi JJ (1967) Mediastinal widening in iatrogenic Cushing's syndrome. Ann Intern Med 67:399–403

    Google Scholar 

  4. Butcher DL, Sahn SA (1979) Epidural lipomatosis: a complication of corticosteroid therapy. Ann Intern Med 90:60

    Google Scholar 

  5. Challoner DR (1969) The direct effect of tri-iodothyronine on the oxygen consumption of rat fat cells. Am J Physiol 216:905–909

    Google Scholar 

  6. Chapman PH, Martuza RL, Poletti CE, Karchmer AW (1981) Symptomatic spinal epidural lipomatosis associated with Cushing's syndrome. Neurosurgery 8:724–727

    Google Scholar 

  7. Clemente DC (ed) (1985) Gray's anatomy. Lea & Febiger, Philadelphia, pp 960–1125

    Google Scholar 

  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 119–204

    Google Scholar 

  9. Fain JN (1981) Catecholamine-thyroid hormone interactions in liver and adipose tissue. Life Sci 28:1745–1754

    Google Scholar 

  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 6:637–647

    Google Scholar 

  11. George WE, Wilmot M, Greenhouse A, Hammeke M (1983) Medical management of steroid-induced epidural lipomatosis. N Engl J Med 308:316–319

    Google Scholar 

  12. Godeau P, Brunet P, Wechsler B, Fohanno D (1979) Lipomatose extradurale compressive accident inhabituel de la corticotherapie (une observation). Nouv Presse Med 8:3889–3891

    Google Scholar 

  13. Goswami A, Rosenberg JN (1978) Thyroid hormone modulation of epinephrine induced lipolysis in rat adipocytes. A possible role of calcium. Endocrinology 103:2223–2233

    Google Scholar 

  14. Guegan Y, Fardoun R, Launois B, Pecker J (1982) Spinal cord compression by extradural fat after prolonged corticosteroid therapy. J Neurosurg 56:267–269

    Google Scholar 

  15. Hall R, Scanlon MF (1979) Hypothyroidism: clinical features and complications. Clin Endocrinol Metab 8:29–38

    Google Scholar 

  16. Klein I, Levey GS (1984) Unusual manifestations of hypothyroidism. Arch Intern Med 144:123–128

    Google Scholar 

  17. Koerner HJ, Sun DIC (1966) Mediastinal lipomatosis secondary to steroid therapy. Am J Roentgenol 98:461–464

    Google Scholar 

  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 59:884–889

    Google Scholar 

  19. Layzer RB (1985) Endocrine disorders. In: Neuromuscular manifestations of systemic disease. Davis, Philadelphia, pp 79–86

    Google Scholar 

  20. Lee M, Lekias J, Gubbay SS, Hurst PE (1975) Spinal cord compression by extradural fat after renal transplantation. Med J Aust 1:201–203

    Google Scholar 

  21. Lipson SJ, Naheedy MH, Kaplan MM, Bienfang DC (1980) Spinal stenosis caused by epidural lipomatosis in Cushing's syndrome. N Engl J Med 302:36

    Google Scholar 

  22. Lucena GE, Bennett WM, Pierre RV (1966) “Dewlap”. A corticosteroid-induced episternal fatty tumor. N Engl J Med 275:834–835

    Google Scholar 

  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 259:3254–3260

    Google Scholar 

  24. Modic MT, Weinstein MA (1984) Nuclear magnetic resonance of the spine. Br Med Bull 40:183–186

    Google Scholar 

  25. Muller MJ, Seitz HJ (1984) Thyroid hormone action on intermediary metabolism. II. Lipid metabolism in hypo- and hyperthyroidism. Klin Wochenschr 62:49–55

    Google Scholar 

  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 141:1147–1152

    Google Scholar 

  27. Price JE Jr, Rigler LG (1970) Widening of the mediastinum resulting from fat accumulation. Radiology 96:497–500

    Google Scholar 

  28. Santini LC, Williams JL (1971) Mediastinal widening (presumable lipomatosis) in Cushing's syndrome. N Engl J Med 284:1357–1359

    Google Scholar 

  29. Sowerbutts JG (1959) Some uses of presacral oxygen insufflation. J Fac Radiol Lond 20:201–206

    Google Scholar 

  30. Watanakunakorn C, Hodges RE, Evans TC (1965) Myxedema: a study of 400 cases. Arch Intern Med 116:183–190

    Google Scholar 

  31. Wenker JC, Baker MK, Ellis JH, Glant MD (1984) Focal fatty infiltration of the liver: demonstration by magnetic resonance imaging. Am J Roentgenol 143:573–574

    Google Scholar 

  32. Williams AL (1983) CT diagnosis of degenerative disc disease: the bulging annulus. Radiol Clin North Am 21:289–300

    Google Scholar 

  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 244:377–383

    Google Scholar 

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Authors and Affiliations

  1. Divisions of Neurology and Neurosurgery, Cook County Hospital, 1835 West Harrison Street, 60612, Chicago, IL, USA

    P. K. Toshniwal & R. P. Glick

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  1. P. K. Toshniwal
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  2. R. P. Glick
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Toshniwal, P.K., Glick, R.P. Spinal epidural lipomatosis: report of a case secondary to hypothyroidism and review of literature. J Neurol 234, 172–176 (1987). https://doi.org/10.1007/BF00314138

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  • DOI: https://doi.org/10.1007/BF00314138

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