Endocrine Abstracts

Aim: Lipedema is a painful fat disorder that affects 11-17% of woman. The diagnosis is based on typical clinical features: bilateral symmetrical disproportionate fatty tissue hypertrophy on the limbs sparing of the hands and feet, feeling of heaviness and tension, easy bruising, transient edema and pain in the affected areas. There are three clinical stages (1, 2 and 3) that refer primarily to appearance of the skin, texture of subdermal tissue and the presence of palpable nodules and fat accumulation. The clinical severity of the disease increases with the stage. The pain is a fundamental diagnostic element but it is not one of the criteria used for staging, it is very variable and a specific and comparable score to quantify it has not yet been validated. The aim of the study was to evaluate the correlation between the pain by pinching the subcutaneous tissue of the lower limbs with clinical history, anthropometric measurement and laboratory tests.

Materials and Methods: 70 women with lipedema underwent clinical evaluation and blood tests. we measured the pain by pinching a skin fold in 6 points of the lower limbs applying a scale from 0 to 4 (0= no pain, 4= maximum pain). the total score ranges from 0 to 24.

Results: All patients had pinch pain, with a total score of 12-24 (mean 19.11±3.57). Based on the clinical stage, we found: 37.1% with stage 1, 38.6% with stage 2 and 24.3% with stage 3. Age, years since disease onset and BMI increase progressively with the clinical stages (P=0.031, P=0.005, P=0.000 respectively). There were no significant differences in the pain score between the 3 clinical stages. There are no significant correlations with white blood cell count, CRP, glucose metabolism indices, estradiol, progesterone, androgen, IGF-1, TSH, FT3 and FT4 levels. The pain score does not correlate with age, disease duration, BMI, waist and hip circumference, WHR or with WHrT. The pain score correlates positively with a single anthropometric parameter: the ratio between hip circumference and height.

Conclusion: The clinical staging currently used for lipedema does not correlate with the pain. Pain should be systematically assessed with a specific score and should be included in the criteria for assessment of clinical severity or staging. The ratio between hip circumference and height, as a new anthropometric index, could be an interesting index for the clinical evaluation of the patient affected by lipedema.