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Why do I have a buffalo hump?

A buffalo hump, also known as a dowager’s hump, is an abnormal fat deposit that develops in the upper back between the shoulders. It creates a hump or bulge, similar to that seen on buffaloes. Buffalo humps are concerning because they can indicate an underlying medical condition.

What causes a buffalo hump?

There are several potential causes for the development of a buffalo hump:

  • Cushing’s syndrome – This condition causes high levels of the hormone cortisol. Too much cortisol leads to fat deposits in the upper back and face.
  • Obesity – Being overweight or obese can lead to increased fat deposits, including in the upper back area.
  • Poor posture – Slouching for long periods can weaken back muscles and cause a hump due to the excessive curvature.
  • Osteoporosis – Weakened and fractured vertebrae in the upper spine may collapse and protrude, creating a hump.
  • Fatty lipoma – A benign tumor made of fat cells can form in the upper back.

Of these, the most common cause of a significant buffalo hump is Cushing’s syndrome, especially when other symptoms are also present. Mild humps may be caused by poor posture or obesity in some cases.

What are the symptoms of Cushing’s syndrome?

Cushing’s syndrome, also called hypercortisolism, has several characteristic symptoms and findings in addition to a buffalo hump:

  • Round, red full face (“moon face”)
  • Excess fat around the neck (“fatty neck”)
  • Obesity of the trunk, but thin arms and legs
  • Pink or purple stretch marks on the skin
  • High blood pressure
  • Muscle weakness
  • Bone loss
  • Hyperglycemia
  • Menstrual disorders in women

Not every person with Cushing’s will have all of these symptoms. Diagnosis is made based on a combination of signs, symptoms, and blood and urine tests.

How is Cushing’s syndrome diagnosed?

If Cushing’s syndrome is suspected based on symptoms, a physician will order laboratory tests to help confirm the diagnosis, including:

  • 24-hour urine test for cortisol
  • Late night salivary cortisol test
  • Low-dose dexamethasone suppression test
  • ACTH levels
  • CRH stimulation test

These tests help determine if cortisol levels are abnormally high for a prolonged period. A 24-hour urine collection to measure cortisol is one of the most accurate ways to screen for Cushing’s syndrome.

Once confirmed, additional testing can help determine the underlying cause. Cushing’s syndrome may be triggered by:

  • Pituitary adenomas – benign tumors that produce excess ACTH
  • Adrenal gland tumors – excess cortisol production
  • Ectopic ACTH production – by tumors elsewhere in the body
  • Medications – especially steroids like prednisone

MRI scans and CT scans of the pituitary and adrenal glands can help identify tumors in those locations. Blood tests can reveal ectopic ACTH-producing tumors.

How is Cushing’s syndrome treated?

Treatment depends on identifying the underlying cause of excess cortisol:

  • Pituitary adenomas: Removal through surgery or radiation therapy to the pituitary gland. Medications may help shrink tumors before surgery.
  • Adrenal tumors: Removal of the adrenal gland tumor through laparoscopic adrenalectomy surgery.
  • Ectopic ACTH: Removal of the source tumor, if possible. Medications to block ACTH or cortisol synthesis.
  • Medications: Discontinuing the steroids or reducing to the lowest effective dose.

Patients are monitored after treatment through blood and urine tests to ensure cortisol levels are normalizing. Resulting symptoms like high blood pressure and diabetes will also need to be managed.

What is the prognosis for Cushing’s syndrome?

With successful treatment of the underlying cause, many symptoms and abnormal findings of Cushing’s syndrome will resolve over the next 12-18 months. However, some effects like osteoporosis may be irreversible.

In cases where the source tumor cannot be located or when there are serious complications, the long-term outlook may be poor. Untreated Cushing’s syndrome can be life-threatening.

The sooner treatment begins, the better the prognosis will be. Therefore, if you develop symptoms like rapid weight gain, emotional changes, pink striae, easy bruising, and a buffalo hump, see your doctor right away.

When to see a doctor

Schedule an appointment with your healthcare provider if you notice:

  • A fatty hump between your shoulders
  • Rapid, unexplained weight gain and redistribution
  • Development of a round, red face
  • New striae or skin changes
  • Uncontrolled hypertension
  • Mood changes like depression or irritability
  • Menstrual disorders in women

A buffalo hump or other Cushingoid features warrant medical evaluation as soon as possible. The earlier Cushing’s syndrome is caught, the more treatment options are available.

When to seek emergency care

Go to an emergency room or urgent care right away if you experience:

  • Sudden severe headache
  • Vision changes or blurred vision
  • One-sided muscle weakness
  • Dizziness or lightheadedness
  • Confusion
  • Seizures

These can indicate a pituitary tumor is bleeding into the brain. Other reasons to seek urgent care include:

  • Fainting episodes
  • Chest pain
  • Shortness of breath
  • Racing heartbeat

These may be signs of heart problems or adrenal crisis in someone with untreated Cushing’s syndrome.


There is no way to prevent Cushing’s syndrome if it is caused by an underlying tumor. However, the following measures may help reduce the risks:

  • Maintain a healthy body weight
  • Exercise regularly
  • Treat conditions like hypertension and diabetes to keep them well-controlled
  • Avoid prolonged steroid use if possible – use the lowest effective doses

Poor posture can potentially contribute to dowager’s humps. Practicing good posture by keeping the head up, shoulders back, and refraining from slouching can help prevent muscle imbalance and spine curvature over time.

Coping and support

Being diagnosed with Cushing’s syndrome and undergoing treatment for tumors can be frightening and stressful experiences. The following strategies may help:

  • Learn as much as you can about your condition and treatment options
  • Communicate openly with your medical team
  • Join a support group to connect with others going through the same thing
  • Enlist friends and family to help you through the process
  • Stay focused day-by-day during treatment and recovery
  • Stay active if possible through walking, stretching, and light exercise
  • Consider counseling or therapy to help manage emotional changes

Dealing with Cushing’s takes time and patience. But support networks, coping strategies, and medical treatments can help you manage symptoms and start feeling like yourself again.


A buffalo hump is an abnormal fat deposit on the upper back that can indicate Cushing’s syndrome. Cushing’s is caused by excess cortisol, often from a pituitary gland or adrenal gland tumor. It requires testing for diagnosis and treatment through surgery, radiation, or medication adjustment.

If a buffalo hump develops along with other Cushingoid features, prompt medical evaluation is important. Catching Cushing’s syndrome early can greatly improve outcomes and prevent potential complications. Staying aware of associated symptoms allows quicker diagnosis and treatment.