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Spinal epidural lipomatosis in children with renal diseases receiving steroid therapy
Kenichi Kano1, Keisho Kyo, Sachio Ito
1Department of Pediatrics, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan. k-kano@dokkyomed.ac.jp
Insights
Steroid-induced spinal epidural lipomatosis (SEL) affects 4% of children on glucocorticoids. Early MRI detection is crucial for obese children with symptoms who receive methylprednisolone pulse therapy.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Radiology
Background:
- Spinal epidural lipomatosis (SEL) is a rare condition.
- Steroid-induced SEL (SSEL) in children is infrequently reported.
- Two hypotheses exist: steroids induce SEL or promote growth of pre-existing SEL, particularly in obese children.
Purpose of the Study:
- To investigate the frequency of SSEL in children with renal diseases treated with glucocorticoids.
- To identify risk factors associated with SSEL in pediatric patients.
- To evaluate the utility of spinal MRI in early SSEL detection.
Main Methods:
- Retrospective analysis of 125 children with renal diseases treated with glucocorticoids over 16 years.
- Investigation of risk factors in 62 SSEL patients from literature.
- Performance of spinal MRI in patients with early symptoms (back pain, numbness), obesity, or those on methylprednisolone pulse therapy.
Main Results:
- SSEL was detected in 5 out of 125 children (4.0%).
- Three of the 5 SSEL patients experienced vertebral compression fractures.
- All 5 SSEL patients were undergoing methylprednisolone pulse therapy.
Conclusions:
- SSEL occurs in 4.0% of pediatric renal disease patients on glucocorticoids.
- Early spinal MRI is recommended for obese children with symptoms receiving methylprednisolone pulse therapy.
- Prompt diagnosis and management can potentially prevent severe complications like vertebral compression fractures.
Abstract:
Spinal epidural lipomatosis (SEL) in patients on steroid therapy may be explained by two hypotheses: (1) steroids induce SEL and (2) steroids cause the growth of a pre-existing SEL, especially in obese children. Steroid-induced SEL (SSEL) is rarely described in children, with only six cases reported elsewhere. However, we have already reported four nephrotic children with SSEL, including one child in another hospital, in addition to the six cases. We investigated the frequency of SSEL in 125 children with renal diseases treated with glucocorticoids in a single hospital over 16 years, and examined the risk factors in 62 patients with SSEL reported in the literature. When patients complained of symptoms at the early stage of SSEL, i.e., back pain or numbness, and patients were obese, we performed spinal magnetic resonance imaging (MRI). SSEL was detected in 5 of 125 children (4.0%). Of the 5 patients with SSEL, 3 had vertebral compression fractures, and all 5 patients were on methylprednisolone pulse therapy. Our study suggests that many more patients can be detected at the early stage of SSEL by performing spinal MRI for patients with early symptoms, obesity, and those who have received methylprednisolone pulse therapy.
