Buffalo hump

Miscellaneous—hypersensitivity reactions, hypokalemia, hypernatremia, increased susceptibility to infection, cushingoid appearance (eg, moon face, buffalo hump, hirsutism), cataracts, and increased intraocular pressure. 

A complex phenomena that promotes the use of fat for energy (a positive effect) and permits fat stores to accumulate in the body, causing buffalo hump and moon- or round-shaped face (a negative effect). 

Differential diagnoses include diabetes mellitus and metabolic syndrome because patients with these conditions share several similar characteristics with Cushing s syndrome patients (e.g., obesity, hypertension, hyperlipidemia, hyperglycemia, and insulin resistance). In women, the presentations of hirsutism, menstrual abnormalities, and insulin resistance are similar to those of polycystic ovary syndrome. Cushing s syndrome can be differentiated from these conditions by identifying the classic signs and symptoms of truncal obesity, "moon faces" with facial plethora, a "buffalo hump" and supraclavicular fat pads, red-purple skin striae, and proximal muscle weakness. 

The most common findings in Cushing s syndrome are central obesity and facial rounding (90% of patients). Peripheral obesity and fat accumulation occur in 50% of patients. Fat accumulation in the dorsocervical area (buffalo hump) is a nonspecific finding, but increased supraclavicular fat pads are more specific for Cushing s syndrome. Patients are often described as having moon facies and a buffalo hump. 

The viral protease is inhibited by several drugs, including indinavir. Surprisingly, such protease inhibitors not only affect the virus but they also affect fat metabolism. They cause loss of adipose tissue in the hmbs and face, which is balanced by its accumulation in other areas, intraabdominal, breasts and over the cervical vertebrae, the last giving rise to the term buffalo hump , a change which is especially distressing for the patient. The cause of this effect is not known. 

Fat redistribution Redistribution/accumulation of body fat, including central obesity, dorsocervical fat enlargement (buffalo hump), peripheral wasting, breast enlargement, and cushingoid appearance have been observed in patients receiving protease inhibitors. 

Other side effects include acne, striae, truncal obesity, deposition of fat in the cheeks (moon face) and upper part of the back (buffalo hump), and dysmenorrhea. Topical administration may produce local skin atrophy. In patients with AIDS who are treated with glucocorticoids, Kaposi s sarcoma becomes activated or progresses more rapidly. 

An adolescent girl with Cushingoid features and osteoporosis took mifepristone 400 mg/day for its antiglucocorticoid effect in an attempt to prevent further bone loss (16). Her striae, weight gain, and buffalo hump markedly improved, and further bone loss was halted. However, with each of the two 6-month courses of mifepristone (9 months apart) she developed massive simple endometrial hyperplasia and a markedly enlarged uterus. This reverted to normal after withdrawal of mifepristone. 

Peripheral lipodystrophy in patients is characterized by fat wasting of the face, limbs, buttocks, and upper trunk, while central adiposity can cause an increase in belly size ( Crix-belly or protease pouch ) and an increase in the dorsocervical fat pad, creating the appearance of a buffalo hump (988-990). These effects may be related to a glucocorticoid-like action. The increase in belly size is... 

Lipid metabolism Cortisol causes the abnormal deposition of a fat pad called buffalo hump. ... 

Accumulation of fat tissue in the abdomen and behind the shoulders (buffalo hump). 

The most common side effects of systemic corticosteroids include behavior disturbances, insomnia, weight gain, and Cushing s syndrome (moon face, buffalo hump, hirsutism, obesity, and easy bruising). Other reactions related to the dose and duration of corticosteroid treatment include hyperglycemia, fluid retention, HTN, electrolyte imbalances. 

There is an important caution for the use of protea.se inhili-itors. As a class, they cause dyslipidetnia. which iiKludci elevated cholesterol and triglycerides and a redistribution ol body fat centrally to cau.se the "protease paunch." buffalo hump, facial auophy. and brea.st enlargement. These agcni< also cau.se hyperglycemia. 

The diabetogenic actions of cortisol may lead to glucose intolerance or overt diabetes mellitus. A peculiar tendency for the disposition of fat in the face (moon facies), posterior neck (buffalo hump), thorax, and abdomen, while sparing the distal extremities, causes a distinct central obesity. ... 

Fat fat accumulation in face, neck, and trunk (protruding abdomen, buffalo hump) hyperlipidemia high cholesterol... 

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