Non HIV-Associated Buffalo Hump as a Clinical Marker of Metabolic Disease

Background/Objectives: Cervicodorsal lipodystrophy, commonly referred to as "buffalo hump," has traditionally been associated with Human Immunodeficiency Virus (HIV)-related antiretroviral therapy. However, similar deformities may also occur independently of HIV treatment. This study aimed to investigate non HIV-associated buffalo hump as a potential clinical marker of underlying metabolic or endocrine disorders. Methods: We retrospectively reviewed 12 HIV-negative patients who presented with cervicodorsal lipodystrophy between 2012 and 2022. Patient demographics, laboratory values, and imaging findings were analyzed. All patients underwent surgical resection of a hypertrophic fat pad. Exploratory statistical analyses were performed using Mann-Whitney U and Fisher's exact tests and Spearman's correlation analysis. Results: These 12 patients had a mean age of 56.92 ± 16.69 years and a mean Body Mass Index (BMI) of 30.15 ± 4.59 kg/m². Hypertension and diabetes were each present in 66.7% of patients, and hyperlipidemia in 75%. Three patients were newly diagnosed with metabolic disease. No significant differences were found between newly diagnosed and previously diagnosed patients in age (45.67 ± 21.46 vs. 60.67 ± 14.31 years, p = 0.194) or BMI (32.44 ± 2.39 vs. 29.39 ± 4.99 kg/m², p = 0.145). Group differences in hypertension, diabetes, hyperlipidemia, or liver dysfunction were also not significant (all p > 0.49). No correlation was observed between age and BMI (ρ = -0.158, p = 0.624). Conclusions: Although the small sample size precludes definitive conclusions, the prevalence of obesity, hypertension, and diabetes in this cohort was notably higher than reported in Korean population-based surveys. These findings suggest that non HIV-associated buffalo hump may serve as an externally visible marker of systemic metabolic burden. Metabolic screening should be considered even in the absence of overt systemic disease.