A rare case of spinal epidural lipomatosis secondary to pituitary Cushing disease presenting with progressive paraparesis

Spinal epidural lipomatosis (SEL) is a rare condition characterized by excessive epidural fat accumulation. Although most cases are secondary to long-term corticosteroid use, SEL due to Cushing disease (CD) is extremely uncommon. A 62-year-old woman presented with progressive paraparesis due to SEL associated with thoracic kyphosis from osteoporotic vertebral fractures. Emergency decompression was performed, followed by endocrine evaluation that revealed pituitary CD. The patient regained full neurological function after surgery. This case represents the third reported instance of SEL caused by pituitary CD requiring spinal surgery. Early recognition and prompt decompression are essential for recovery.