What Is a Buffalo Hump (Dorsocervical Fat Pad)—and Why Does It Happen?

A buffalo hump (medically known as a dorsocervical fat pad) occurs when you develop a buildup of fat in between the shoulder blades at the back of the neck. The excess fat can form a fatty tissue protrusion that mimics the appearance of a hump.

A buffalo hump on its own is not harmful, and having it does not ultimately mean you have a medical condition. Sometimes, even having poor posture can cause it. However, certain conditions like Cushing's syndrome, adrenal cancer, osteoporosis, and obesity can raise your risk of developing one.

Buffalo Hump Symptoms

The hallmark characteristic of a buffalo hump is a fatty lump behind the neck, in between the back of the shoulders. In most cases, this is actually the only symptom. However, conditions like Cushing's syndrome, adrenal cancer, obesity, or osteoporosis is causing the hump, can cause additional symptoms such as:

• A round or moon face
• Unintentional weight gain
• Thin arms and legs
• Muscle weakness
• Easy bruising
• Purple stretch marks, particularly on the breasts, abdomen, and hips

Causes

Several underlying conditions can cause a buffalo hump. The following are the most common reasons:

• Poor posture: Leaning forward, keeping your head down (such as while looking at your phone), and not walking with your shoulders pushed back can weaken the muscles in your neck and upper back and cause a hump to develop.
• Cushing's syndrome: This condition causes the overproduction of cortisol, a hormone that plays an important role in how the body responds to stress. The overproduction of this hormone sometimes triggers fat accumulation in the back of the neck.
• Adrenal cancer: The adrenal gland is the gland responsible for secreting cortisol. A cancerous tumor growing in this gland can cause it to overproduce cortisol, leading to the development of a buffalo hump.
• Antiretroviral medications: Certain HIV medications, such as protease inhibitors, can cause side effects like a buffalo hump.
• Glucocorticoids: Long-term use of glucocorticoid medications like Rayos (prednisone) and Hydrocort (hydrocortisone) can cause a buffalo hump, as these medications act like cortisol and therefore induce similar effects as high cortisol levels.
• Obesity: People who live with obesity have a higher risk of developing a buffalo hump due to excess fat deposits in the neck region.
• Lipodystrophy: This refers to a group of medical conditions characterized by abnormal fat distribution in the body. People with this condition often lack fat tissue in all or some parts of the body but have excess fat accumulation in other body parts.
• ​​Madelung disease (multiple symmetrical lipomatosis): This condition is a rare metabolic disorder that causes an unusual build-up of fat deposits in body parts like the trunk, neck, shoulders, thighs, and upper arms. It is often associated with excessive alcohol use.

Diagnosis

Healthcare providers can diagnose a buffalo hump by physically or visually examining you. However, they may need to run further tests to determine the underlying cause of the hump. This may include taking your medical and family history and ordering exams that check cortisol level, bone density, and strength, such as:

• Imaging tests like magnetic resonance imaging (MRI) scans, computed tomography (C)T scans, and X-rays
• Blood tests
• Urine tests
• Bone density tests

Because certain medications can also raise the risk of developing a buffalo hump, you can expect your healthcare provider to ask you about your medication use and other lifestyle habits.

How To Get Rid of a Buffalo Hump

There’s no one-size-fits-all treatment for a buffalo hump. Your healthcare team's approach to resolving a hump will often depend on the cause of your symptoms. Your exact treatment plan may also combine multiple treatment options together to see results. Treatment approaches to help reduce the appearance of a buffalo hump include the following:

• Use a posture corrector and sitting or walking straight to fix posture
• Focus on nutritious foods to help your body lose weight if needed
• Start an exercise regimen to manage obesity
• Stop or adjust the dosage of any medications that may be causing your hump
• Get cosmetic surgery to remove the excess fat deposit on the neck
• Remove tumors from the back of the neck or the adrenal gland, which may cause high cortisol levels
• Manage stress to reduce high cortisol levels, which can influence a buffalo hump to develop
  

Prevention

There is no surefire way to prevent a buffalo hump, but incorporating the following strategies may reduce your risk of developing one:

• Exercise regularly to maintain strong bones
• Eat a nutritious diet, focusing on plant foods like fruits and vegetables, lean proteins, and whole grains
• Limit the use of glucocorticoid medications

Complications 

A buffalo hump itself doesn't typically pose a danger to your health. However, in some people, the fat accumulation can be so excessive that it restricts neck or upper back movement. This can affect your ability to move, complete daily tasks, and feel more self-conscious about your body image.

However, if the underlying medical causes of a buffalo hump, like Madelung disease and Cushing's syndrome, are not treated in a timely manner, they may lead to complications like hypertension (high blood pressure), depression, sleep apnea (a chronic breathing disorder that causes your breathing to stop and restart repeatedly while you sleep), and difficulty swallowing or speaking.

That said, if you develop a buffalo hump, seeing a healthcare provider about the hump is important, as they can offer treatment options to help reduce the appearance and treat underlying conditions.

Living With a Buffalo Hump

The development of buffalo hump is often not within your control, and it can be challenging to live with this fat accumulation behind your neck, as it can limit mobility. It is best to speak to a healthcare provider as soon as you notice the hump, especially to learn if an underlying health condition is causing your symptoms. They can provide an accurate diagnosis and offer timely treatment options.

Some people who develop a buffalo hump can also sometimes experience changes in their self-perception, body image, and emotional well-being. However you feel is normal and valid—and it's also okay to reach out to a mental healthcare provider if you need support. Online support groups for conditions like Cushing's syndrome can also help you feel cared for and understood by other people living with the condition.