steroid lipomatosis

Diagnostic Tests for Steroid-Induced Spinal Epidural Lipomatosis (SEL)

Steroid-induced spinal epidural lipomatosis (SEL) is a rare condition characterized by the accumulation of fatty tissue in the epidural space, leading to compression of the spinal cord. The diagnosis of SEL is primarily based on imaging studies.

Imaging Modalities

The gold standard for diagnosing SEL is Magnetic Resonance Imaging (MRI). MRI with and without Gadolinium is the preferred modality due to its superior ability to discriminate fat content during imaging [4, 6]. T1-weighted images are particularly useful in detecting the fatty tissue accumulation in the epidural space.

Other Diagnostic Tests

While MRI is the primary diagnostic tool for SEL, other imaging modalities such as Computed Tomography (CT) scans can also be used to diagnose this condition. However, CT scans may not provide the same level of detail as MRI [7].

Additional Testing

In some cases, additional testing may be necessary to confirm the diagnosis and rule out other conditions. This may include:

• Ultrasound: May be used to evaluate the size and location of the lipoma.
• Biopsy: A tissue sample removal for lab examination may be performed in some cases.

Citation

[4] AA Salman (2024) - The imaging modality of choice for diagnosing SEL is Magnetic Resonance Imaging (MRI) with and without Gadolinium, with a thickness >7 mm of extramedullary fat. [6] D Alnabwani (2022) - MRI is the diagnostic modality of choice due to its superior and selective ability to discriminate fat content during imaging. T1-weighted images are particularly useful in detecting the fatty tissue accumulation in the epidural space. [7] S Podlewski - The main tool of diagnostic process in SEL is MRI. Epidural lipomatosis can also be diagnosed by CT. In tomography, adipose tissue is hypodense compared to muscle.

Treatment Options for Steroid Lipomatosis

Steroid lipomatosis, also known as Dercum disease, is a rare condition characterized by the growth of multiple lipomas (fatty tumors) on the skin and underlying tissues. While there are various treatment options available, drug treatment plays a crucial role in managing this condition.

Medical Management

For mild cases of steroid lipomatosis, medical management represents first-line treatment [2]. This approach includes:

• Weight loss: Reducing body weight can help alleviate symptoms and slow down the growth of new lipomas.
• Physical therapy: Gentle exercises and physical therapy can help improve mobility and reduce pain.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen or naproxen can help manage pain and inflammation.

Steroid Inhibitors

In more severe cases, steroid inhibitors such as metyrapone or ketoconazole may be prescribed to reduce the production of steroids in the body [4], [8]. These medications can help shrink existing lipomas and prevent new ones from forming.

Other Alternatives

Other alternatives for treating steroid lipomatosis include:

• Epidural steroid injections: Injecting corticosteroids directly into the affected area can help reduce inflammation and alleviate symptoms [7]. *

Spinal epidural lipomatosis (SEL) is a rare condition characterized by an overgrowth of unencapsulated adipose tissue in the extradural space, which can compress surrounding neural structures and lead to neurological deficits. When considering differential diagnoses for SEL, several conditions should be excluded.

• Encapsulated spinal lipomas: These are benign tumors composed of fatty tissue that are typically well-defined and encapsulated, unlike SEL which is characterized by an overgrowth of unencapsulated adipose tissue.
• Spinal stenosis: This condition involves narrowing of the spinal canal, which can cause compression of neural structures and symptoms similar to those experienced in SEL. However, spinal stenosis is typically caused by degenerative changes or congenital conditions rather than an overgrowth of fatty tissue.
• Degenerative joint disease: This refers to wear and tear on joints due to aging or repetitive motion, which can lead to compression of neural structures and symptoms similar to those experienced in SEL. However, degenerative joint disease is typically caused by mechanical factors rather than an overgrowth of fatty tissue.

Other conditions that should be excluded when considering differential diagnoses for SEL include:

• Neurofibromatosis type 1: This is a genetic disorder characterized by the growth of non-cancerous tumors on nerve tissue. While it can cause neurological symptoms, it is typically associated with other characteristic features such as café-au-lait macules and axillary or inguinal freckling.
• Legius syndrome: Also known as NF1-like syndrome, this is a rare genetic skin pigmentation disorder characterized by multiple café-au-lait macules with or without axillary or inguinal freckling.

It's worth noting that direct injection of steroids into benign lipomas has been reported as an alternative to excision, but this should not be considered in the differential diagnosis for SEL.