EPIDURAL LIPOMATOSIS NOT INDUCED BY CORTICOSTEROID-THERAPY - 3 CASES INCLUDING ONE IN A PATIENT WITH PRIMARY CUSHINGS-DISEASE - (REVIEW OF THE LITERATURE)

We report three cases of epidural lipomatosis including one in a patie nt with primary Cushing's disease. Our literature review found 16 addi tional cases of symptomatic epidural lipomatosis in patients who were not receiving corticosteroids. The presenting symptoms were nonspecifi c. The main clinical symptoms were nerve root pain, weakness of the lo wer limbs upon exertion, paraparesis or isolated back pain. Degenerati ve lesions were common and were sometimes the cause of the symptoms. C ases were evenly distributed between the thoracic and lumbar spine. Of the 18 patients, 14 were men and eight were older than 54 years. Thre e-fourths of patients were obese. Spinal cord or nerve root compressio n occurred in some instances. Modern imaging techniques (computed tomo graphy and magnetic resonance imaging) can establish the diagnosis rap idly. In patients without neurologic compromise, surgery should be con sidered only if symptoms fail to respond to weight reduction. The rate of occurrence of epidural lipomatosis in patients with Cushing's dise ase is probably underestimated. Routine investigation by magnetic reso nance imaging of Cushing's disease patients who have manifestations kn own to occur in epidural lipomatosis would allow to evaluate the role of increased production of endogenous corticosteroids in the occurrenc e of epidural lipomatosis.