What is the timeframe for developing Cushingoid features, such as moon face and buffalo hump, after initiating corticosteroid (steroid) therapy, and what dose is required for these symptoms to occur?

From the Guidelines

Moon face and buffalo hump can develop within weeks to months after starting corticosteroid therapy, typically at doses exceeding 7.5-10 mg daily of prednisone or equivalent steroids. These symptoms, part of Cushing's syndrome, result from the redistribution of fat tissue caused by steroids' metabolic effects, particularly their impact on fat metabolism and storage. The face becomes rounder as fat accumulates in the cheeks, while the buffalo hump forms as fat deposits at the base of the neck and upper back.

Key Points to Consider

• The timeline for developing moon face and buffalo hump varies significantly between individuals, but higher doses increase the risk and may accelerate symptom onset, with some patients developing noticeable facial changes within 2-4 weeks at doses of 20-40 mg daily 1.
• These physical changes are generally reversible when steroids are tapered or discontinued, though resolution may take months.
• Patients should be aware that these side effects are dose-dependent and should discuss concerns with their healthcare provider, who may consider alternate-day dosing or steroid-sparing medications if appropriate.
• The optimum corticosteroid dosing schedule is not known, and dosing schedules are largely empirical and based on practical experience, with some studies advocating for initial doses of prednisolone 1 mg kg-1 per day (or equivalent) in most cases, and 0.5–1 mg kg-1 in milder cases 1.
• Treatment failure is defined by international consensus as continued disease activity or failure to heal despite 3 weeks of prednisolone 15 mg kg-1 per day, or equivalent, and may require consideration of alternate corticosteroid-sparing agents or adjustments in treatment strategy 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Development of Moon Face and Buffalo Hump

• Moon face and buffalo hump are symptoms associated with Cushing's syndrome, which can be caused by exogenous steroid use 2.
• The development of these symptoms can occur after starting long-term, high-dosage systemic corticosteroid therapy 3.
• A prospective study found that the cumulative incidence rate of corticosteroid-induced lipodystrophy (CIL), which includes moon face and buffalo hump, was 61% at 3 months and 69% at 12 months 3.

Dose and Risk Factors

• The study found that an initial daily dosage of 20 mg or more of prednisone was associated with a higher risk of developing CIL 3.
• Risk factors for CIL included being female, being younger than 50 years old, having a high initial body mass index, and having a high energy intake 3.
• The dose of steroids needed to develop these symptoms can vary, but high-dosage therapy (>20 mg/d) is a significant risk factor 3.

Time Frame for Development

• The time frame for developing moon face and buffalo hump can vary, but symptoms can occur as early as 3 months after starting high-dosage steroid therapy 3.
• The cumulative incidence rate of CIL continues to increase over time, with 69% of patients developing symptoms at 12 months 3.