A fat accumulation at the base of the neck, often referred to as a “Buffalo Hump,” is medically known as a dorsocervical fat pad. This condition is characterized by a localized buildup of fat around the seventh cervical vertebra (C7) and the upper thoracic spine. This fatty deposit should be distinguished from a “Dowager’s Hump,” a bony curvature of the upper spine (kyphosis) that results from conditions like osteoporosis or poor posture. While the dorsocervical fat pad is a physical manifestation of fat storage, it frequently points toward an underlying medical issue affecting the body’s hormonal balance or metabolism.
Hormonal Imbalances and Endocrine Disorders
The primary medical cause for the development of a dorsocervical fat pad is an excess of the hormone cortisol, a condition known as Cushing’s Syndrome. Cortisol plays a role in regulating metabolism and the body’s response to stress. When cortisol levels are consistently too high, the hormone triggers a redistribution of fat tissue throughout the body.
This high cortisol environment causes what is called centripetal obesity, where fat is preferentially stored in the central areas of the body, including the abdomen, face (“moon face”), and the dorsocervical region. Cortisol binding to receptors in fat cells promotes fat synthesis and storage in these specific depots while simultaneously causing fat loss in the limbs.
Other endocrine disorders and metabolic disturbances can also contribute to this specific fat accumulation, though Cushing’s Syndrome is the most direct cause. Severe, uncontrolled metabolic syndrome is frequently accompanied by generalized central obesity, which can include the neck region. Furthermore, rare conditions like Madelung’s disease, a type of multiple symmetrical lipomatosis, can cause unusual and extensive fat deposits, including the dorsocervical fat pad, often linked to alcohol use.
Medication Side Effects and Weight Gain
A common cause of the dorsocervical fat pad is the long-term, high-dose use of systemic corticosteroid medications. Drugs like prednisone, hydrocortisone, and dexamethasone are synthetic glucocorticoids that act similarly to natural cortisol, leading to the same fat redistribution pattern. Patients taking these steroids for chronic inflammatory or autoimmune conditions may experience this side effect due to the medication-induced excess of glucocorticoid activity.
Another distinct external factor is the use of certain older antiretroviral medications for treating Human Immunodeficiency Virus (HIV). This development is part of a condition called lipodystrophy, which is characterized by abnormal fat distribution. Older classes of drugs, such as protease inhibitors, were strongly associated with this side effect, causing both fat accumulation in areas like the neck (lipohypertrophy) and fat loss in other areas. Newer HIV treatments are significantly less likely to cause this particular fat accumulation.
While these hormonal and drug-related causes create the localized fat hump, generalized weight gain also plays a part. Severe or rapid weight gain can lead to excess fat deposition throughout the body, including the dorsocervical area.
Medical Assessment and Management Strategies
Medical assessment focuses on identifying and treating the underlying cause. The diagnostic process begins with a comprehensive physical examination and a review of the patient’s medical history, including any current or past use of corticosteroid or antiretroviral medications. The physician will look for other signs of hypercortisolism, such as facial rounding, easy bruising, and central obesity.
Further diagnosis involves laboratory tests to measure hormone levels, particularly cortisol. Tests like the 24-hour urinary free cortisol or the overnight dexamethasone suppression test are used to confirm or rule out an active Cushing’s Syndrome. Imaging studies may also be employed to assess the extent of the fat accumulation.
Management strategies are then directly aimed at correcting the root cause of the fat accumulation. If the cause is a medication, the treatment involves safely adjusting or switching the drug regimen under medical supervision. For Cushing’s Syndrome, treatment may involve surgery to remove a tumor or medication to lower cortisol production. The dorsocervical fat pad may gradually decrease in size once the hormonal imbalance is resolved. For persistent fat pads, cosmetic removal options such as liposuction or surgical excision are available to address functional or aesthetic concerns.