LAUSR

BACKGROUND Steroid-related spinal epidural lipomatosis (SEL) is a well-known condition most commonly encountered in patients taking chronic steroid medications. Endogenous Cushing's syndrome is a rare cause of SEL. The authors report an unusual presentation of acute thoracic myelopathy due to SEL with osteoporotic vertebral compression fractures in a patient with Cushing's disease. CASE DESCRIPTION A 33-year old man, presented thoracic myelopathy due to SEL and multiple vertebral compression fractures. He had Cushingoid clinical features and investigations revealed a pituitary micro adenoma as the cause of hypercortisolism. The diagnosis was missed on multiple occasions before the onset of paraparesis. The patient was treated with urgent thoracic laminoplasty followed by transsphenoidal surgery (TSS) on the same day. Although normalization of the serum cortisol levels was delayed by six months, he had a complete neurological recovery and remains symptom-free at two years follow-up. CONCLUSION This is a rare presentation of Cushing's disease and is reported only twice before in the 1990s. This case reports highlights the need to keep a high degree of suspicion for development of thoracic myelopathy in a patient with Cushing's syndrome who develops thoracic compression fractures associated with SEL. Early recognition of this clinical association and addressing the primary endocrine problem urgently could have prevented spinal cord involvement and the subsequent spine surgery. This scenario is also revealed in previous published case reports of this association where the diagnosis of Cushing's syndrome has been revealed retrospectively after the development of neurological symptoms.