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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Endocrinology

Building a Foundation: Understanding Multiple Symmetric Lipomatosis

At a Glance

Multiple Symmetric Lipomatosis (MSL), or Madelung's disease, is a rare metabolic disorder causing large, non-cancerous fat masses to grow symmetrically. Unlike normal fat, it doesn't respond to diet or exercise, and large masses can press on airways or nerves, requiring careful medical management.

If you have recently been diagnosed with Multiple Symmetric Lipomatosis (MSL), you may feel a mix of confusion and relief at finally having a name for the changes in your body. Also known as Madelung’s disease or Launois-Bensaude syndrome, MSL is a rare metabolic disorder characterized by the growth of large, symmetric, non-cancerous fat masses [1][2].

Unlike typical weight gain, the fat in MSL does not respond to diet or exercise [3]. Understanding the nature of this condition is the first step toward managing it and advocating for your care.

What is MSL?

MSL is not the same as standard obesity or common lipomas. In most people, a lipoma (a benign fatty lump) is “encapsulated,” meaning it sits inside a thin fibrous sac like a grape in its skin. In MSL, the fat is non-encapsulated—it grows freely and can blend into the surrounding normal tissue, making it more difficult to define and treat [4][5].

The fat deposits in MSL are hyperplastic, meaning the fat cells are multiplying in number rather than just growing larger [6]. Researchers believe this is caused by a “glitch” in how the body processes fat, possibly linked to mitochondrial dysfunction—a problem with the “power plants” of your cells [7][8].

Who is Affected?

MSL is considered a rare disease and predominantly affects:

  • Sex and Age: It is most common in middle-aged men, though it can occur in women [1][2].
  • Ethnicity: There is a higher reported incidence among people of Mediterranean and Eastern European descent [1].
  • The Role of Alcohol: There is a very strong clinical association between MSL and chronic alcohol consumption [1][9]. However, it is important to know that MSL also occurs in people who drink very little or no alcohol at all [10][11]. While reducing alcohol is often recommended to help slow the progression, it is not the sole “cause” of the disease, and non-drinkers should not feel their diagnosis is any less valid.

Identifying the Patterns

Doctors often classify MSL into two main types based on where the fat is located:

  1. Type I: Fat deposits are concentrated in the neck, upper back (sometimes called a “buffalo hump”), shoulders, and upper arms [12][13].
  2. Type II: Fat is distributed more widely across the trunk, hips, and upper thighs, which can sometimes be mistaken for simple obesity [12][14].

Validating Your Experience

It is important to stabilize your expectations with these core facts:

  • It is Benign: MSL is not a form of cancer [1]. The fat masses are benign, meaning they do not spread to other organs like a malignant tumor would.
  • Physical Impact: While benign, these masses can be obstructive. If they grow large enough around the neck, they can press on the windpipe (trachea) or food pipe (esophagus), leading to difficulty breathing or swallowing [11][15].
  • Nerve Health: Many people with MSL also experience peripheral neuropathy—numbness, tingling, or weakness in the hands and feet [16][11]. This is a known part of the disease process, not just a side effect of weight.
  • A Chronic Journey: MSL is a long-term condition. Even after surgical removal (lipectomy) or liposuction, there is a high rate of recurrence because the underlying metabolic “glitch” remains [17][18].

MSL can be a visually distressing and physically uncomfortable condition. Diagnosis is the first step toward a management plan that focuses on your quality of life, comfort, and long-term health monitoring.

Common questions in this guide

What is the difference between MSL and regular weight gain?
Unlike typical weight gain, the fat deposits in MSL are caused by rapidly multiplying cells and do not respond to diet or exercise. The fat is also non-encapsulated, meaning it blends into surrounding normal tissues rather than being contained in a distinct sac.
Is Multiple Symmetric Lipomatosis a type of cancer?
No, MSL is completely benign. While the fat masses can grow very large and cause physical complications like breathing issues or nerve pain, they are not cancerous and do not spread to other organs like a malignant tumor would.
Does alcohol consumption cause Madelung's disease?
There is a strong link between chronic alcohol consumption and MSL, but alcohol is not the only cause. MSL also occurs in people who drink very little or no alcohol at all, as the disease is primarily driven by underlying metabolic and mitochondrial dysfunction.
What are the different types of MSL?
MSL is typically divided into two categories based on where fat grows. Type I involves fat deposits concentrated around the neck, upper back, shoulders, and upper arms. Type II features widespread fat distribution across the trunk, hips, and upper thighs.
Will the fat masses return after surgical removal?
Yes, there is a high rate of recurrence for MSL even after surgical removal or liposuction. This happens because treatments only remove the existing fat but cannot cure the underlying metabolic issue that causes new fat cells to multiply.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on the distribution of my fat deposits, do I have Type I or Type II MSL, and how does this affect my prognosis?
  2. 2.What imaging (like an MRI or CT scan) is needed to see if these deposits are pressing on my airway or nerves?
  3. 3.Can we screen for common MSL-related issues, such as peripheral neuropathy or metabolic changes?
  4. 4.Given the high recurrence rate of MSL, what is your experience with surgical removal versus liposuction for this specific condition?
  5. 5.Since MSL can be linked to mitochondrial function, are there any genetic tests you recommend?

Questions For You

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References

References (18)
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    Madelung's disease. Two case reports with pseudoathletic appearance.

    Miraglia E, Moliterni E, Iacovino C, et al.

    La Clinica terapeutica 2021; (172(3)):190-192 doi:10.7417/CT.2021.2311.

    PMID: 33956034
  2. 2

    IMAGES IN CLINICAL MEDICINE. Madelung's Disease.

    Nisi G, Sisti A

    The New England journal of medicine 2016; (374(6)):572 doi:10.1056/NEJMicm1503861.

    PMID: 26863358
  3. 3

    Shedding Light on Multiple Symmetric Lipomatosis: An Overlooked Syndrome in the Evaluation of Obesity.

    Saraiva M, Ferreira LMD, Carvalho R

    The American journal of case reports 2023; (24()):e941751 doi:10.12659/AJCR.941751.

    PMID: 38039195
  4. 4

    Could Madelung disease be a cause of stroke? A rare case report.

    Tosunoğlu B, Altıkardeş M, Arık EP, et al.

    Folia medica 2024; (66(4)):583-586 doi:10.3897/folmed.66.e116329.

    PMID: 39257262
  5. 5

    Symmetric Lipomatosis Arising in the Tongue Presenting as Macroglossia and Articulatory Disorder.

    Kudoh M, Omura K, Satsukawa A, et al.

    Case reports in otolaryngology 2016; (2016()):2061649 doi:10.1155/2016/2061649.

    PMID: 27413566
  6. 6

    Adipose Tissue in Multiple Symmetric Lipomatosis Shows Features of Brown/Beige Fat.

    Schiltz D, Tschernitz S, Ortner C, et al.

    Aesthetic plastic surgery 2020; (44(3)):855-861 doi:10.1007/s00266-020-01666-6.

    PMID: 32157376
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    Research progress on the pathogenesis of multiple symmetrical lipomatosis.

    Hu B, Wang Z, Ma T, et al.

    Adipocyte 2024; (13(1)):2416681 doi:10.1080/21623945.2024.2416681.

    PMID: 39648639
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    Madelung lipomatosis presenting as a manifestation of myoclonic epilepsy with ragged red fibers (MERRF) syndrome.

    Gilson RC, Osswald S

    JAAD case reports 2018; (4(8)):822-823 doi:10.1016/j.jdcr.2018.05.004.

    PMID: 30238046
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    Multiple Symmetric Lipomatosis.

    Prahlow SP, Kosciuk P, Prahlow JA

    Journal of forensic sciences 2018; (63(1)):312-315 doi:10.1111/1556-4029.13536.

    PMID: 28643398
  10. 10

    Madelung's disease in a non-alcoholic Ethiopian male patient mistaken for obesity: a case report.

    Zewde YZ

    BMC endocrine disorders 2021; (21(1)):142 doi:10.1186/s12902-021-00803-9.

    PMID: 34217263
  11. 11

    A case report of Multiple Symmetric Lipomatosis (MSL) in an East Asian Female.

    Jung K, Lee S

    BMC women's health 2020; (20(1)):200 doi:10.1186/s12905-020-01055-w.

    PMID: 32928192
  12. 12

    Do you know this syndrome? Type 2 benign symmetric lipomatosis (Launois-Bensaude).

    Esposito AC, Munhoz T, Abbade LP, Miot HA

    Anais brasileiros de dermatologia 2016; (91(6)):840-841 doi:10.1590/abd1806-4841.20164744.

    PMID: 28099616
  13. 13

    Multiple symmetric and multiple familial lipomatosis.

    Lemaitre M, Chevalier B, Jannin A, et al.

    Presse medicale (Paris, France : 1983) 2021; (50(3)):104077 doi:10.1016/j.lpm.2021.104077.

    PMID: 34687914
  14. 14

    Madelung disease with postoperative priapism and multiple venous thromboses: case report and literature review.

    Guo L, Li W, Xu X, Xiao H

    Frontiers in cardiovascular medicine 2024; (11()):1449556 doi:10.3389/fcvm.2024.1449556.

    PMID: 39257843
  15. 15

    A case of severe obstructive sleep apnoea in Madelung's disease treated by lateral pharyngoplasty.

    Pinto V, Morselli PG, Tassone D, Piccin O

    The Journal of laryngology and otology 2017; (131(9)):834-837 doi:10.1017/S0022215117001062.

    PMID: 28532519
  16. 16

    Madelung's Disease Leading to Presenile Dementia in a Non-alcoholic Patient.

    El Hasbani G, Assaker R, Nithisoontorn S, et al.

    Medical archives (Sarajevo, Bosnia and Herzegovina) 2019; (73(4)):285-287 doi:10.5455/medarh.2019.73.285-287.

    PMID: 31762567
  17. 17

    Madelung's disease -a case series from a single-center experience.

    Łącka M, Wojciechowska J, Bernecka P, et al.

    Frontiers in surgery 2025; (12()):1636822 doi:10.3389/fsurg.2025.1636822.

    PMID: 41113128
  18. 18

    A case report of Madelung's disease in China.

    Wanke J, Yongjing F

    Radiology case reports 2022; (17(2)):320-325 doi:10.1016/j.radcr.2021.10.035.

    PMID: 34876958

This page provides educational information about Multiple Symmetric Lipomatosis (MSL) and Madelung's disease. It is not a substitute for professional medical advice, diagnosis, or treatment from your healthcare provider.

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