Medscape is available in 5 Language Editions – Choose your Edition here.


Adiposis Dolorosa Workup

  • Author: Laura F McGevna, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Feb 06, 2015

Laboratory Studies

Results of hormonal studies to rule out Cushing syndrome, thyroid abnormalities, and other endocrinologic abnormalities are characteristically normal.

Dercum disease (adiposis dolorosa) Patients might have associated slight-to-moderate rises of cholesterol levels.

Erythrocyte sedimentation rate results may be slightly elevated.

Coagulation test results are normal.

In spite of obesity, hypertension and type 2 diabetes mellitus seldom occur.

An increase in certain active parameters is seen in the following: sedimentation rate; alpha-1-antitrypsin; orosomucoid (alpha-1-acid glycoprotein, an acute phase reactant); haptoglobin; and complement factors C3, C4, Clq, and Cls.[10, 11]

The heat produced by the fat cells when measured with a microcalorie meter is approximately twice as high as that taken from people who are extremely overweight.

The ratio of monounsaturated fatty acid (16:1, 18:1) in the fatty tissue is greater than that of saturated fatty acid (14:1, 18:0) shown by a comparison with healthy people in controls.[24, 26]

The levels of substance P in the cerebrospinal fluid is significantly lower compared with healthy weight-matched controls. However, the average in both cases is above the normal level.[27] The level of the neuropeptide Y is on the lower side of normal, and B-endorphin is on the higher side (H. Brorson, B. Fagher, R. Ekman; unpublished data).


Imaging Studies

Ultrasonography and magnetic resonance imaging (MRI) may aid in the diagnosis of Dercum disease (adiposis dolorosa).[23, 28]

On MRI, the lesions appear oblong, and this may be due to septal distortion that is seen on histopathological evaluation. In a study by Tins et al of 13 patients with Dercum disease (adiposis dolorosa), lesions of the condition were found to be markedly hyperechoic on ultrasound, superficial in location, and distinct from characteristic lipomas.[29] Further, when validated on more than 6000 MRIs, they appeared as ill-defined, nodular, “blush-like” subcutaneous fat on unenhanced MRI with a decreased T1-weighted signal. No case of Dercum’s disease was without these features in the study, and the authors concluded that these findings, along with multiple subcutaneous fatty lesions, is “very suggestive and possibly pathognomonic” for the condition.


Histologic Findings

A review of histopathologic findings did not reveal any significant features that might distinguish Dercum disease (adiposis dolorosa) tumors from the common sporadic lipomas. Minor features that were detected include a slight accumulation of perivascular lymphocytes and plasma cells and extremely large fat cells compared with those of healthy controls of similar weight. The tumors can be encapsulated, or the fatty deposits can be diffuse.

Contributor Information and Disclosures

Laura F McGevna, MD Assistant Professor of Medicine, Dermatology Division, University of Vermont College of Medicine

Laura F McGevna, MD is a member of the following medical societies: American Academy of Dermatology, Dermatology Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Catharine Lisa Kauffman, MD, FACP Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, Royal Society of Medicine, Women's Dermatologic Society, American Medical Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


Tammie Ferringer, MD Dermatopathology Section Head, Dermatopathology Fellowship Director, Departments of Dermatology and Pathology, Geisinger Medical Center

Tammie Ferringer, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology, and International Society of Dermatopathology

Disclosure: Nothing to disclose. Nada Macaron, MD Consultant Pathologist, Institute of Pathology and Laboratory Medicine, Sheikh Khalifa Medical city, UAE

Nada Macaron, MD is a member of the following medical societies: College of American Pathologists and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Marjan Yousefi, MD Department of Dermatology, Geisinger Medical Center

Marjan Yousefi, MD is a member of the following medical societies: American Academy of Dermatology and Phi Beta Kappa

Disclosure: Nothing to disclose.

  1. Dercum FX. Three cases of a hitherto unclassified affection resembling in its grosser aspects obesity, but associated with special symptoms: adiposis dolorosa. Am J Med Sci. 1892. 104:521-35.

  2. Schaffer PR, Hale CS, Meehan SA, Shupack JL, Ramachandran S. Adiposis dolorosa. Dermatol Online J. 2014 Dec 16. 20(12):[Medline].

  3. Herbst KL, Asare-Bediako S. Adiposis Dolorosa is More than Painful Fat. Endocrinologist. 2007 Nov/Dec. 76(6):326-34.

  4. Palmer ED. Dercum's disease: adiposis dolorosa. Am Fam Physician. 1981 Nov. 24(5):155-7. [Medline].

  5. Brodovsky S, Westreich M, Leibowitz A, Schwartz Y. Adiposis dolorosa (Dercum's disease): 10-year follow-up. Ann Plast Surg. 1994 Dec. 33(6):664-8. [Medline].

  6. Hansson E, Svensson H, Brorson H. Depression in Dercum's disease and in obesity: a case control study. BMC Psychiatry. 2012 Jul 3. 12:74. [Medline]. [Full Text].

  7. Roux J, Vitaut M. Maladie de Dercum (Adiposis dolorosa). Revue Neurol (Paris). 1901. 9:881-88.

  8. Stern H. Adiposis dolorosa with myxoedematous manifestations. Am J Med Sci. 1910. 139:359-63.

  9. Hansson E, Svensson H, Brorson H. Review of Dercum's disease and proposal of diagnostic criteria, diagnostic methods, classification and management. Orphanet J Rare Dis. 2012 Apr 30. 7:23. [Medline]. [Full Text].

  10. Greenbaum SS, Varga J. Corticosteroid-induced juxta-articular adiposis dolorosa. Arch Dermatol. 1991 Feb. 127(2):231-3. [Medline].

  11. Skagen K, Petersen P, Kastrup J, Norgaard T. The regulation of subcutaneous blood flow in patient with Dercum's disease. Acta Derm Venereol. 1986. 66(4):337-9. [Medline].

  12. Lynch HT, Harlan WL. Hereditary Factors in Adiposis Dolorosa (Dercum's Disease). Am J Hum Genet. 1963 Jun. 15(2):184-90. [Medline].

  13. Cantu JM, Ruiz-Barquin E, Jimenez M, Castillo L, Macotela-Ruiz E. Autosomal dominant inheritance in adiposis dolorosa (Dercum's disease). Humangenetik. 1973 Mar 23. 18(1):89-91. [Medline].

  14. Campen R, Mankin H, Louis DN, Hirano M, Maccollin M. Familial occurrence of adiposis dolorosa. J Am Acad Dermatol. 2001 Jan. 44(1):132-6. [Medline].

  15. Leites SM, Davtian NK, Emanuel' VIa. [Pathophysiological characteristics of adipose tissue in Dercum's syndrome]. Patol Fiziol Eksp Ter. 1972 Jan-Feb. 16(1):47-51. [Medline].

  16. Blomstrand R, Juhlin L, Nordenstam H, Ohlsson R, Werner B, Engstrom J. Adiposis dolorosa associated with defects of lipid metabolism. Acta Derm Venereol. 1971. 51(4):243-50. [Medline].

  17. Gamez J, Playan A, Andreu AL, et al. Familial multiple symmetric lipomatosis associated with the A8344G mutation of mitochondrial DNA. Neurology. 1998 Jul. 51(1):258-60. [Medline].

  18. Silvestri G, Ciafaloni E, Santorelli FM, et al. Clinical features associated with the A-->G transition at nucleotide 8344 of mtDNA ("MERRF mutation"). Neurology. 1993 Jun. 43(6):1200-6. [Medline].

  19. Rasmussen JC, Herbst KL, Aldrich MB, Darne CD, Tan IC, Zhu B, et al. An abnormal lymphatic phenotype is associated with subcutaneous adipose tissue deposits in Dercum's disease. Obesity (Silver Spring). 2014 Oct. 22(10):2186-92. [Medline]. [Full Text].

  20. Stallworth JM, Hennigar GR, Jonsson HT Jr, Rodriguez O. The chronically swollen painful extremity. A detailed study for possible etiological factors. JAMA. 1974 Jun 24. 228(13):1656-9. [Medline].

  21. Giudiceandrea V. L’adiposis dolorosa (malattia di Dercum). Riv Patol Nerv Ment. 1900. V:289-304.

  22. Haddad D, Athmani B, Costa A, Cartier S. [Dercum's disease: a severe complication in a rare disease. A case report]. Ann Chir Plast Esthet. 2005 Jun. 50(3):247-50. [Medline].

  23. Amine B, Leguilchard F, Benhamou CL. Dercum's disease (adiposis dolorosa): a new case-report. Joint Bone Spine. 2004 Mar. 71(2):147-9. [Medline].

  24. Freedberg IM, Eisen AZ, Wolff K et al, eds. Neoplasms of subcutaneous fat. Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999. Vol 1: 1348-9.

  25. Bhandari R. Resident rounds: Part III. Calciphylaxis in the setting of non-hemodialysis, rapid weight loss, and mixed hyperparathyroidism. J Drugs Dermatol. 2014 Feb. 13(2):208-9. [Medline].

  26. Fagher B, Monti M, Nilsson-Ehle P, Akesson B. Fat-cell heat production, adipose tissue fatty acids, lipoprotein lipase activity and plasma lipoproteins in adiposis dolorosa. Clin Sci (Lond). 1991 Dec. 81(6):793-8. [Medline].

  27. Hansson E, Manjer J, Svensson H, Åberg M, Fagher B, Ekman R, et al. Neuropeptide levels in Dercum's disease (adiposis dolorosa). Reumatismo. 2012 Jul 19. 64(3):134-41. [Medline].

  28. Tins BJ, Matthews C, Haddaway M, Cassar-Pullicino VN, Lalam R, Singh J, et al. Adiposis dolorosa (Dercum's disease): MRI and ultrasound appearances. Clin Radiol. 2013 Oct. 68(10):1047-53. [Medline].

  29. Tins BJ, Matthews C, Haddaway M, Cassar-Pullicino VN, Lalam R, Singh J, et al. Adiposis dolorosa (Dercum's disease): MRI and ultrasound appearances. Clin Radiol. 2013 Oct. 68(10):1047-53. [Medline].

  30. Campen RB, Sang CN, Duncan LM. Case records of the Massachusetts General Hospital. Case 25-2006. A 41-year-old woman with painful subcutaneous nodules. N Engl J Med. 2006 Aug 17. 355(7):714-22. [Medline].

  31. Iwane T, Maruyama M, Matsuki M, Ito Y, Shimoji K. Management of intractable pain in adiposis dolorosa with intravenous administration of lidocaine. Anesth Analg. 1976 Mar-Apr. 55(2):257-9. [Medline].

  32. Petersen P, Kastrup J. Dercum's disease (adiposis dolorosa). Treatment of the severe pain with intravenous lidocaine. Pain. 1987 Jan. 28(1):77-80. [Medline].

  33. Gonciarz Z, Mazur W, Hartleb J, et al. Interferon alfa-2b induced long-term relief of pain in two patients with adiposis dolorosa and chronic hepatitis C. J Hepatol. 1997 Dec. 27(6):1141. [Medline].

  34. Steiner J, Schiltz K, Heidenreich F, Weissenborn K. [Lipomatosis dolorosa--a frequently overlooked disease picture]. Nervenarzt. 2002 Feb. 73(2):183-7. [Medline].

  35. Singal A, Janiga JJ, Bossenbroek NM, Lim HW. Dercum's disease (adiposis dolorosa): a report of improvement with infliximab and methotrexate. J Eur Acad Dermatol Venereol. 2007 May. 21(5):717. [Medline].

  36. Desai MJ, Siriki R, Wang D. Treatment of pain in Dercum's disease with Lidoderm (lidocaine 5% patch): a case report. Pain Med. 2008 Nov. 9(8):1224-6. [Medline].

  37. Lange U, Oelzner P, Uhlemann C. Dercum's disease (Lipomatosis dolorosa): successful therapy with pregabalin and manual lymphatic drainage and a current overview. Rheumatol Int. 2008 Nov. 29(1):17-22. [Medline].

  38. Labuzek K, Liber S, Suchy D, Okopieå BA. A successful case of pain management using metformin in a patient with adiposis dolorosa. Int J Clin Pharmacol Ther. 2013 Jun. 51(6):517-24. [Medline].

  39. Herbst KL, Coviello AD, Chang A, Boyle DL. Lipomatosis-associated inflammation and excess collagen may contribute to lower relative resting energy expenditure in women with adiposis dolorosa. Int J Obes (Lond). 2009 Sep. 33(9):1031-8. [Medline]. [Full Text].

  40. Hansson E, Svensson H, Brorson H. Liposuction may reduce pain in Dercum's disease (adiposis dolorosa). Pain Med. 2011 Jun. 12(6):942-52. [Medline].

  41. Haddad D, Athmani B, Costa A, Cartier S. [Dercum's disease: a severe complication in a rare disease. A case report]. Ann Chir Plast Esthet. 2005 Jun. 50(3):247-50. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.