What diagnostic measures are available?

Normally, an inspection (looking at) the legs of the affected person is sufficient for the diagnosis of lipedema. Here the thick legs can be seen, which often have an orange peel skin with many dents. The increased tendency to bruising can also usually be detected at a glance.

It is also possible to feel small “globules” under the skin. These are initially very small, but can grow up to walnut size. They consist of fatty tissue and stored liquid.

In contrast to other edemas, lipedema does not leave a dent after the skin has been pressed in. However, the thighs in particular are sensitive to pressure and pain. One examination that can be performed is the test for the Stemmer’s sign.

This is negative in the presence of lipedema, which means that the skin over the fingers and toes can be lifted. The structural changes under the skin can also be determined by ultrasound. Therefore, ultrasound is often used for the final diagnosis.

Causes of lipedema

The causes for the development of lipedema are not yet fully understood. Almost exclusively girls and women are affected by lipedema, which is why experts suspect hormonal causes. Lipoedema can occur spontaneously or over time as a result of lipohypertrophy, an increase in subcutaneous fatty tissue.

It is probable that there is an inherited component, as about 20% of those affected have other cases within the family. Lipoedema is characterized by an increased accumulation of subcutaneous fatty tissue, but the process is different from “normal” weight gain. This means that in lipoedema no individual fat cells grow, but the fat tissue itself changes: the number of fat cells increases, so that the fat tissue of the subcutis becomes thicker.

It also becomes more and more firmly structured. As a result, the fat cells form palpable nodules in the subcutis. Lipedema also leads to microangiopathy, a disease of the smallest blood vessels (capillaries).

This leads to an increase in the permeability of the tiny capillaries. At the same time, there is increased filtration in the vessels, which means that more water from the blood passes through the vessel walls into the surrounding tissue. This leads to the formation of an edema above the connective tissue covering layer (fascia).

This water congestion can cause pressure sensitivity and pain when pressure is applied.Over time and as the disease progresses, the lymphatic vessels become strained and lymph drainage is disrupted, so that lymphedema can develop as a result of the lipedema. The reason for the development of lipedema is not fully understood. The tendency for the development of lipedema is probably hereditary.

In about 20% of those affected, there are other cases within the family. There are concomitant diseases that are more frequently diagnosed in patients with lipedema. These include diseases of the thyroid gland, such as hyperthyroidism, hypofunction or Hashimoto’s thyroiditis.

Hashimoto’s thyroiditis is an autoimmune disease that leads to chronic thyroiditis. In the long term, an underactive thyroid gland develops in the course of the disease. However, since the exact cause of the development of lipedema is not yet known, no scientific connection between the occurrence of lipedema and thyroid dysfunction can be proven. Nevertheless, many people affected by lipedema report an accompanying underfunction of the thyroid gland or Hashimoto’s thyroiditis, in which an underfunction also occurs.