Swollen limbs, could it be lipoedema?

A chronic condition, lipoedema is caused by an abnormal build-up of fat cells in the legs, thighs and buttocks, and sometimes in the arms. An oncologist and an endocrinologist, both practicising at Mediclinic hospitals, explain how this condition is diagnosed and treated.

‘Lipoedema is usually associated with an abnormal accumulation of fat deposits under the skin. We don’t really understand the causes of this condition clearly yet,’ explains Dr Lizanne Langenhoven, a clinical and radiation oncologist at Cancercare and Mediclinic Panorama.

‘We believe there might be a genetic predisposition to the condition, and we know it normally occurs in women after menopause. Lipoedema can also exist in combination with lymphoedema (see below), worsening the swelling of the affected area even further. We usually advise that patients see an endocrinologist to exclude underlying hormonal imbalances and direct the treatment team,’ she adds.

Dr Marli Conradie, an endocrinologist practising at Mediclinic Durbanville, explains that lipoedema is usually seen in patients who have an increased body weight. ‘Therefore, obesity or a high body mass index would be the important underlying condition to address.’

‘It is always important to exclude any possible secondary causes for the excess weight, some of which are rare. More common problems may be hypothyroidism, depression or menopause, which may complicate the issue. Medical treatment alone for weight issues is often very unsatisfactory. It is important to have a multifactorial approach in patients with lipoedema and offer them the necessary support to change lifestyle factors and address psychological issues. This could involve including ancillary medical professionals such as psychologists and dieticians to support the patient in losing the necessary weight,’ Dr Conradie concludes.

Is lipoedema the same as lymphoedema?

No but they are related conditions.

‘Lymphoedema is usually caused by a disruption in the lymphatic drainage of a specific part of the body,’ explains Dr Langenhoven. ‘Lymph is a term we use loosely to refer to the fluid between cells. This fluid is generally drained through small lymphatic pathways similar to arteries and veins,’ she adds.

‘This pathway passes through the lymph nodes into the systemic circulation. When the lymphatic pathway is disrupted, the lymphatic fluid can’t drain as efficiently as before and causes swelling in the area where the drainage through the lymph nodes is impaired. This complication is associated with many conditions, but is probably best known following surgical removal of the lymph nodes in breast cancer.’