Back

Buffalo Hump

What Is It, Causes, Treatment, and More

Author: Georgina Tiarks

Editors: Ahaana Singh, Józia McGowan, DO

Illustrator: Jillian Dunbar

Copyeditor: Joy Mapes

Modified: 28 Dec 2023


What is a buffalo hump?

Buffalo hump,” or a dorsocervical fat pad, is a term that refers to a collection of excess fat behind the neck that causes the shoulders to develop a hump-like shape. It can be caused by a variety of underlying conditions or medications.

What causes a buffalo hump?

A buffalo hump is most commonly a result of Cushing syndrome, a disorder of excess cortisol, a naturally occurring hormone that is involved in a variety of bodily processes, such as metabolism. High levels of the hormone cortisol can lead to increased fat synthesis. With Cushing syndrome, the fat produced often deposits in the neck, known as lipodystrophy. This produces the characteristic buffalo hump. Cushing syndrome may be caused by an adrenal tumor, lung tumor, or glucocorticoid medications. If Cushing syndrome is caused by a pituitary tumor, it is known as Cushing disease

Long-term use of glucocorticoid medications, which raise levels of cortisol in the body, can increase the risk of developing a buffalo hump. Glucocorticoids, such as prednisone, act as anti-inflammatory and immune-suppressive medications. They are most commonly prescribed to treat autoimmune diseases, allergies, asthma, chronic obstructive pulmonary disease (COPD), and skin conditions. They may also be prescribed along with chemotherapy to treat cancer. 

Buffalo humps have also been seen in patients being treated for HIV infection, suggesting that HIV-associated buffalo hump may be due to treatment with antiretroviral drugs.  

 In addition, Madelung disease, a rare disorder that causes fat depositions on the body, may cause a buffalo hump to develop if the fat masses are localized to the neck. 

Moreover, obesity can also play a role in the development of a buffalo hump due to increased fat deposition

Excited Mo character in scrubs
Join millions of students and clinicians who learn by Osmosis!
Start Your Free Trial

What are the signs and symptoms of buffalo humps?

In addition to the characteristic hump that presents between the shoulder blades, individuals may experience other symptoms depending on the underlying cause. In cases involving high levels of cortisol in the body (e.g., Cushing syndrome, use of glucocorticoid medications), individuals may experience weight gain around the face (i.e., moon face), stretch marks, excess hair growth (i.e., hirsutism), acne, thinning skin, delayed wound healing, and flushing of the skin. Cushing syndrome can also cause elevated glucose levels (i.e., hyperglycemia), high blood pressure (i.e., hypertension), abnormal lipid levels (i.e., dyslipidemia), irregular menstrual cycles, excessive thirst, osteoporosis, neurological changes, depression, and decreased libido. 

How is a buffalo hump diagnosed?

To diagnose a buffalo hump and its underlying cause, a healthcare professional generally will review the individual’s current medications and medical history, as well as conduct a physical examination.  

Depending on the suspected cause, the clinician may order lab tests, such as a 24-hour urinary free cortisol (UFC) test, a late-night salivary cortisol level, a low-dose dexamethasone test, or a high-dose dexamethasone test. These tests evaluate one’s cortisol levels and can help determine the diagnosis of underlying conditions. Imaging studies, such as X-ray, magnetic resonance imaging (MRI), or computerized tomography (CT) scans, may also be ordered to help differentiate between fat deposits and spinal changes. 

How is a buffalo hump treated?

Treatment of a buffalo hump is largely dependent on the cause. If the underlying cause is due to medication use, a healthcare professional may want to alter the medication dosage or stop it altogether. In the case of Cushing syndrome, surgery or prescription medications may be required to address the elevated cortisol levels. Treatment of Madelung disease may include cosmetic surgery to remove the fat deposition.

Additionally, a healthcare provider may recommend a diet and exercise regimen to reduce fat accumulation. Certain medications may also be prescribed to help alleviate associated signs and symptoms.

Can a buffalo hump go away?

Yes, a buffalo hump can go away in some circumstances. Despite regression of the buffalo hump, depending on the underlying cause, some individuals may be at increased risk of developing other disorders such as sleep apnea, cardiovascular disease, heart attack (i.e., myocardial infarction), stroke, and thromboembolism.

What are the most important facts to know about buffalo humps?

A buffalo hump, also known as a dorsocervical fat pad, refers to a collection of fat accumulated on the back of the neck, between the shoulder blades. It can be caused by a variety of underlying medical conditions, like Cushing syndrome, as well as certain medications. Additional symptoms may accompany a buffalo hump depending on the underlying cause. Diagnosis may require a physical exam, review of medical history, lab work, and imaging studies. Treatment options primarily focus on resolving the underlying cause and may include pharmaceutical therapy, surgical removal, or cessation of medications. In some cases, lifestyle changes may also be recommended. Treatment may result in regression of the buffalo hump

Quiz yourself on Buffalo Hump

10 Questions available

Quiz now!

Watch related videos:

Mo with coat and stethoscope

Want to Join Osmosis?

Join millions of students and clinicians who learn by Osmosis!

Start Your Free Trial

Related links

Adrenal masses: Pathology Review
Cushing syndrome and Cushing disease: A Pathological Review
Protease inhibitors

Resources for research and reference

Fardet, L., Cabane, J., Lebbé, C., Morel, P., & Flahault, A. (2007). Incidence and risk factors for corticosteroid-induced lipodystrophy: a prospective study. Journal of the American Academy of Dermatology, 57(4): 604–609. DOI: 10.1016/j.jaad.2007.04.018

Icahn School of Medicine at Mount Sinai. (n.d.). Hump behind the shoulders (dorsocervical fat pad). In Mount Sinai: Health library. Retrieved April 5, 2021, from https://www.mountsinai.org/health-library/symptoms/hump-behind-the-shoulders-dorsocervical-fat-pad

Liu, S.-Z., Zhou, X., Wang, Y.-P., Liu, Y., & Song, A. (2020). The Madelung’s disease and the buffalo hump sign. QJM: An International Journal of Medicine, 113(3): 219. DOI: 10.1093/qjmed/hcz160

Lo, J., Mulligan, K., Tai, V., Algren, H., & Schambelan, M. (1998). “Buffalo hump” in men with HIV-1 infection. Lancet (London, England), 351(9106): 867-870. DOI: 10.1016/S0140-6736(97)11443-X

Mallon, P., Wand, H., Law, M., Miller, J., Cooper, D., Carr, A., HIV Lipodystrophy Case Definition Study, & Australian Lipodystrophy Prevalence Survey Investigators. (2005). Buffalo hump seen in HIV-associated lipodystrophy is associated with hyperinsulinemia but not dyslipidemia. Journal of Acquired Immune Deficiency Syndrome, 38(2): 156-162. DOI: 10.1097/01.qai.0000147527.64863.1a

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2018). Cushing’s syndrome. Retrieved April 5, 2021, from https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome