A “buffalo hump,” medically known as a dorsocervical fat pad, describes an accumulation of excess fatty tissue located at the base of the neck and upper back. This visible bulge can vary in size and shape. While often benign, its presence can sometimes indicate an underlying health concern. It can also be a source of discomfort and self-consciousness for those affected.
Underlying Medical Conditions
Several medical conditions can lead to a buffalo hump by influencing fat distribution in the body. One primary cause is Cushing’s syndrome, a disorder characterized by prolonged exposure to high levels of the hormone cortisol. This excess cortisol, whether produced by the body or introduced externally, triggers fat redistribution, leading to accumulations including the neck and upper back.
Beyond hormonal imbalances, structural issues can also contribute. Severe osteoporosis, a condition causing bone weakening, can lead to vertebral compression fractures in the upper spine. These fractures result in an exaggerated forward curvature of the upper back, known as kyphosis or a “dowager’s hump,” which can mimic or contribute to a buffalo hump’s appearance.
Disorders affecting fat metabolism, termed lipodystrophy, can also cause localized fat deposits. This involves an abnormal fat distribution, where some body areas lose fat while others, like the neck and upper back, accumulate it. Rare conditions like Dercum’s disease (adiposis dolorosa) are characterized by multiple, painful growths of fatty tissue (lipomas) that can occur just below the skin, including in this region.
Madelung’s disease, also known as multiple symmetrical lipomatosis, is an uncommon metabolic disorder that causes non-encapsulated fatty masses to accumulate symmetrically in various body parts, including the neck. While distinct from generalized obesity, these conditions specifically alter how fat is stored, contributing to localized bulges.
Medication-Induced Development
Certain medications can cause a buffalo hump as a side effect, primarily by influencing fat redistribution. Long-term use of systemic corticosteroids, such as prednisone, often prescribed for inflammatory or autoimmune conditions, is a common culprit. These medications mimic the effects of cortisol in the body, leading to fat accumulation in the neck and upper back, similar to Cushing’s syndrome.
Another class of medications includes certain older generation antiretroviral drugs (ARVs) used in HIV treatment. These drugs can induce lipodystrophy, causing fat loss in some areas while promoting accumulation in others, including the neck and upper back. Newer antiretroviral therapies are less likely to cause this side effect.
Other Contributing Elements
Beyond specific medical conditions and medications, several other factors can contribute to a buffalo hump’s appearance or exacerbation. General obesity can make any pre-existing fat accumulation in the upper back more pronounced, as fat is often deposited in the neck and shoulder region with significant weight gain.
Some individuals may also have a genetic predisposition to store fat in this region, even without significant overall weight gain. Poor posture, particularly a chronic forward curvature of the upper spine (kyphosis), can create a visual effect similar to a hump. While this “dowager’s hump” is primarily due to skeletal alignment rather than a fatty deposit, it can be confused with or contribute to the appearance of a true buffalo hump.
Diagnosis and Management Strategies
Diagnosing the cause of a buffalo hump typically begins with a thorough physical examination and a detailed medical history review by a healthcare professional. This includes inquiring about current medications, past medical conditions, and any family history of relevant disorders. Further diagnostic tests may be necessary to identify the underlying reason for the fat accumulation.
Blood tests are often conducted to evaluate hormone levels, particularly cortisol, if Cushing’s syndrome is suspected. Imaging studies, such as X-rays, MRI, or CT scans, may be ordered to provide detailed views of tissue and bone structure, helping to differentiate between a fatty deposit and a spinal curvature.
Management of a buffalo hump primarily focuses on addressing its underlying cause. If a medical condition like Cushing’s syndrome is identified, treatment involves managing the hormone imbalance, which might include medication adjustments or, in some cases, surgical intervention for tumors. For medication-induced humps, a doctor may adjust the dosage or switch to alternative drugs, though this should only be done under strict medical supervision.
Lifestyle modifications, such as weight management through a balanced diet and regular exercise, can help reduce the hump’s size if obesity is a contributing factor. Posture correction exercises and physical therapy can be beneficial for humps related to kyphosis. If the hump is significant, causes discomfort, or does not respond to other treatments, surgical options like liposuction or direct excision might be considered, typically as a last resort.