Epidural hibernoma as a complication of corticosteroid treatment

Abstract

Centripetal fat deposition is a well-recognized consequence of excessive use of corticosteroids, either endogenous or exogenous. Recently, several patients receiving large doses of corticosteroids have suffered compressive myelopathies due to excessive epidural fat collections, labeled "epidural lipomatosis." Two of these have been children, and a third child is reported here. This child was receiving chronic steroids for juvenile rheumatoid arthritis when he presented with such a myelopathy, which was confirmed by metrizamide computerized tomography myelography as well as by surgical exploration. Histological examination revealed that the epidural tissue was a brown-fat tumor or "hibernoma." An epidural hibernoma has not been described previously. The histological and endocrine features of fat in Cushing's syndrome are discussed, and the literature concerning hibernoma and epidural lipomatosis is reviewed.

Dorsal epidural spinal lipomatosis

“…Although the mean age of patients with SL reported in literature is 43 years, the disorder tends to occur at a younger age in male patients 2 3. The youngest patient with SL was a 6-year-old boy who was receiving high-dose steroid therapy 4. Our case report describes an overweight patient discovered to have a SEL in the thoracic spine.…”

Severity of presentation is associated with time to recovery in spinal epidural lipomatosis

“…In the 17 surgical patients with available data, the time course of patients' neurological deterioration was noted in days [6][7][8]10,11,13,14,17,18,20,23,24,[26][27][28][29][30][32][33][34]36,37]. The duration of symptoms refers to the period of time between when the patient first reported noticing symptoms and their definitive surgery.…”

“…In 22 patients, both the cumulative dose of prednisone and the extent of ultimate recovery could be assessed [7,8,10,11,13,14,17,18,20,[22][23][24][26][27][28][29][30]. Five of these patients were managed conservatively with reduction of their steroid dose, 13 were managed with surgery alone and four were managed with both surgery and steroid reduction.…”

“…4). In 16 of the patients treated surgically, there was sufficient description in the reports to analyze both the cumulative dose of prednisone and the timing of postoperative recovery [6][7][8]10,11,18,20,[22][23][24][26][27][28][29]. The timing of recovery was graded as either delayed or rapid.…”

Spinal epidural lipomatosis. Case report and review of the literature

“…Laboratory studies showed mild elevation of alanine-aminotransferase 53-77 U/1 (1 040), elevated triglyceride 4.2 mmolil (0.4-1 .S), low serum testosterone 6.1 nmol/l (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), and the serum cortisol was normal.…”