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Cortisol/Buffalo Hump, Addison's/HIV connection?
Dec 26, 2000

Dear Dr. Cohen:

I read with great interest the post re liposuction used to reduce a buffalo hump. The patient noted that success was limited because the hump was "too fibrous". Your response acknowledged that "there is tremendous uncertainty about what is causing this fat and fibrous tissue to accumulate".

I, too, have a buffalo hump -- but I do not have HIV. I have had some degree of a hump since I was a child (I'm 47 now) but I had accepted and ignored it up until about 15 years ago. At that time I underwent surgery to remove the hump for cosmetic reasons. Back then the surgeon didn't perform a liposuction, but he did do some sort of scraping procedure.

After the surgery, my doctor told me that there was limited success because the hump, which he had originally thought was a lipoma, was "too fibrous". I still have the remaining part of the hump. What's interesting is that the part that was removed has never returned, even though I've gained a considerable amount of weight. Now, 15 years post-surgery and once again tired of hiding the disfigurement, I'm looking to rule out Cushings as the cause of the hump, which brings me to my belabored point.

My hump -- very fibrous -- is almost certainly due to hypercortisolism (no matter what the cause).

That said, isn't it likely that HIV patients are developing buffalo humps as a result of treatment-induced hypercortisolism? And don't they suffer from additional treatment-induced Cushings-like side effects as well? And aren't HIV symptoms similar to Addison's (the "opposite" disorder of Cushings)?

In conclusion, isn't the successful treatment of HIV likely to be discovered via some variation of the treatment of Addisons?

Thank you in advance for your time and any response you might give.

S. S

Response from Dr. Cohen

The similarity of the appearance of Cushings and lipodystrophy led researchers to first focus on whether this was the explanation. Since you are right to suggest that there is some striking overlap in how these two conditions look, including the quality of the fatty tissue.

However, the frustrating news was that there is no evidence of Cushings in those who have this with HIV. And it really was explored by endocrinologists who would know how to check. And so the search goes on to see how this rare event would happen in the body, since apparently Cushings is just one way that this can happen, but not the only. Sadly, we don't for sure know WHY there is the hump in Cushings - just that there is an association. But there is no evidence of excess adrenal steroids in the case of those with HIV - so the mystery continues.

That has been the nature of HIV and treatment - for each step of progress, there has been light shed on other places where we have still much to learn to make this work out better.

Hope that helps.

CC

Cal Cohen, M.D., M.S.



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