What Does a Buffalo Hump Look Like?
A buffalo hump appears as a dramatic accumulation of fat in the dorsocervical region (back of the neck), creating a visible rounded prominence or hump between the shoulders and base of the neck. 1
Physical Appearance and Clinical Features
The buffalo hump manifests as abnormal fat and fibrous tissue accumulation in the dorsocervical area, creating a distinct rounded contour at the upper back and neck junction 2
This fat pad enlargement is visually striking and represents one of the most recognizable physical signs when present, particularly in conditions causing fat redistribution 1, 3
The prominence can range from mild to severe, with more advanced cases showing dramatic dorsocervical fat accumulation that significantly alters the neck and upper back contour 4
Associated Physical Findings in Your Patient Context
Given your patient is a 40-year-old woman on estrogen replacement therapy with hyperhidrosis, the following considerations are important:
Buffalo hump in the context of steroid therapy (including estrogen) typically appears alongside other cushingoid features: moon facies (rounded face), central obesity, and facial plethora 5, 3
When buffalo hump develops from corticosteroid-induced lipodystrophy, it presents with cervical fat pad enlargement that occurs in approximately 69% of patients on long-term high-dose steroids by 12 months 6
The appearance may be accompanied by truncal fat accumulation with a significantly greater proportion of fat in the trunk region compared to extremities 4
Important Clinical Context
In women specifically, the risk of developing visible buffalo hump from corticosteroid therapy is significantly higher (OR: 10.87) compared to men, making this finding more likely in your female patient 6
The development of buffalo hump does not always indicate Cushing's syndrome—it can occur from exogenous hormone therapy, HIV-associated lipodystrophy, or other causes of fat redistribution without hypercortisolism 4
Critical screening needed: When you identify a buffalo hump, immediately screen for Cushing's syndrome with 24-hour urinary free cortisol, late-night salivary cortisol, or low-dose dexamethasone suppression test, as this represents a potentially serious endocrine disorder 7
Distinguishing Features by Cause
Steroid-induced buffalo hump: Appears with moon facies, purple striae, proximal muscle weakness, and easy bruising 7, 3
HIV-associated lipodystrophy: Buffalo hump occurs with mixed pattern showing central adiposity and peripheral lipoatrophy (fat loss in extremities) 8
The hyperhidrosis in your patient may represent an associated metabolic or endocrine abnormality requiring evaluation for insulin resistance, diabetes, and other metabolic complications 7