Madelung’s Disease: Analysis of Clinical Characteristics, Fatty Mass Distribution, Comorbidities and Treatment of 54 Patients in China

Abstract

Purpose Madelung’s disease (MD) is a rare disease characterized by the deposition of unencapsulated fat masses on the face, neck, chest, back and other areas of patients. The aim of the study was to analyze the clinical characteristics, comorbidities and treatment of MD in Chinese populations. Patients and Methods We retrospectively reviewed the medical records of 54 patients who were diagnosed with MD at the Affiliated Hospital of Qingdao University and Qingdao Municipal Hospital from January 2005 to February 2021 and collected the subjects’ demographic information, clinical indicators, location of fat deposits, treatment, complications and prognostic data. Results Among 54 MD patients in the study, only 1 (1.85%) was female, and the subjects had an average age of 56.65 ± 7.93 years. More than 70% of patients had a history of long-term smoking or/and alcohol abuse. In our study, type I accounted for approximately 61.11% of cases according to Donhauser’s classification, and almost all patients had neck fat deposition. MD patients often have multiple comorbidities across several systems, such as the endocrine, digestive, circulatory, urinary, and neurological systems. Among these, endocrine system diseases were the most common comorbidities in our study, accounting for 81.48%. Notably, up to 20.37% of cases were complicated with cancer, especially digestive system tumors. More than 70% of the patients received surgical treatment, and nearly 40% experienced postoperative recurrence. Conclusion Considering that MD patients often have comorbidities of multiple systems and that a small number of cases are even complicated by cancer, we recommend that clinicians comprehensively assess a patient’s condition and complications, advocate that patients quit consuming alcohol and smoking as soon as possible, establish healthy dietary and living habits, and formulate individualized and comprehensive diagnosis and treatment plans.

A Case Report of Madelung's Disease

“…A recent systematic review of MD cases showed that majority of patients are located in Europe (79.7%), especially Portugal (37%) and Italy (21.3%). In Asian populations, only sporadic cases and a few systematic retrospective analyses have been reported in recent years [7].…”

“…In Asian populations, only sporadic cases and a few systematic retrospective analyses have been reported in recent years. 7 Although the etiology of MD is not clearly understood, several factors have been identified in its development. These include alcoholism, HIV, 6 and 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.…”

“…4 The diagnosis of MD may be established using clinical data, physical examination, and imaging such as computed tomography, 5 ultrasonography, or MRI. 7,9 The images show symmetrically distributed unencapsulated fatty tissue accumulating within the subcutaneous tissue along the vascular and muscular planes. Other diseases, such as morbid obesity, lipoma, liposarcoma, neurofibroma, and salivary gland disorders, should be ruled out.…”

“…In Asian populations, only sporadic cases and a few systematic retrospective analyses have been reported in recent years. 7 …”

Type 1C Multiple Symmetrical Lipomatosis: A Cause of Misdiagnosis in Females

“…The dismal outlook for MSL may be explained by its many comorbidities. A postoperative recurrence occurred in nearly 40% of all patients, who had surgical therapy in more than 70% of cases [ 13 ]. In a study investigating postoperative recurrence in MSL patients, a combination of age, BMI, alcoholism, and comorbidities were reported as factors likely to influence recurrence [ 14 ].…”