Extreme hyperalphalipoproteinaemia in a patient with a solitary paraspinal lipoma

Increased high-density lipoprotein (HDL)-cholesterol (hyperalphalipoproteinaemia; HALP) is commonly genetic, but may have secondary causes. An association between multiple lipomatosis and HALP has been reported; however, the mechanism for this is unclear. We report the case of a 69-year-old Cook Island woman with extreme HALP who presented with a large paraspinal lipoma. Magnetic resonance imaging showed no other lipomas. She had the metabolic syndrome, a family history suggestive of lipomas and was on lipid-lowering and antihypertensive therapy. Her plasma HDL-cholesterol concentration was 4.9 mmol/L (>95th percentile for age and sex) and was not explained by typical secondary causes. HDL(2) and HDL(3) subfractions were increased, with HDL(2) predominance. The excised lipoma histology demonstrated benign tissue and normal karyotype. Postoperative lipid profiles showed no change in HDL-cholesterol concentrations. In summary, we report a case of extreme HALP that persisted after excision of a solitary paraspinal lipoma.