Obesity with painful nodules or fat masses

Introduction Painful obesity is mainly characterized by the appearance of painful nodules or fat masses on the basis of obesity. Adiposis dolorosa is a rare autonomic nervous system disease of unknown etiology. It is characterized by abnormal accumulation of subcutaneous fat in some parts of the body, accompanied by spontaneous pain in this part. This disease was first described by Dercum (1892), so it is also known as Dercum's disease.

Cause

(1) Causes of the disease

The disease may be related to metabolic disorders. There are also reports that it is related to immune dysfunction but has not yet been elucidated.

(two) pathogenesis

The pathogenesis is unknown. In the past, it was thought to be related to hypothalamic and endocrine disorders. However, Pimenta et al. (1992) confirmed that the pituitary, adrenal gland, thyroid gland and gonads have normal secretion function, and patients are found to have peripheral insulin resistance. Normal intake and oxidation, low response to norepinephrine, lack of insulin anti-fat solubilization, it is believed that this disease may be related to metabolic disorders. Local pain may be caused by abnormal fat accumulation affecting the cutaneous nerve, and pain sensation may be caused by cutaneous nerve degeneration. Other literature suggests that it is associated with immune dysfunction but has not yet been elucidated.

an examination

Related inspection

Neurological examination of brain CT examination

1. The majority of female patients with this disease, the age of onset is mostly 30 to 50 years old, that is, women of childbearing age, often accompanied by early arrest, early decline in sexual function and other symptoms. The main manifestation is that there are painful nodules or fat masses on the basis of obesity, and the fat is deposited on the trunk, neck, ankle and waist and buttocks. Early fat nodules are soft and hard at the end. As the fat nodules increase, the pain increases, and numbness, weakness, and sweating disorders occur.

2. The nature of the pain is acupuncture or knife-like pain, which is paroxysmal or persistent, and there may be tenderness along the nerve trunk. Often associated with joint pain, systemic weakness is a prominent symptom, but no evidence of organic lesions.

3. The disease is chronically progressive, often with psychiatric symptoms such as depression and mental retardation, as well as mental decline, and a tendency to develop into dementia.

Differential diagnosis

A characteristic painful fat nodule appears on the basis of obesity and can be diagnosed according to the age and gender of onset.

1. Nodular febrile nonsuppurative panniculitis is a chronic course with repeated episodes of scattered subcutaneous nodules, but no spontaneous pain, normal skin color or red, brown or purple Most patients have fever, and often accompanied by skin lesions. The pathological manifestations are mainly the inflammatory reaction of subcutaneous fat and steatosis and necrosis.

2. Many patients with multiple neurofibromatosis often have many milk-coffee spots on their skin. Histopathological biopsy confirmed neurofibromatosis.

3. Multiple angiolipomas are characterized by tenderness and few spontaneous pains. The diagnosis can be confirmed by histopathological biopsy of lipoma.

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