🩺 Cushing's Moon Face & Buffalo Hump Mechanism Simulator

Normal Body Habitus Before Cortisol Excess

Healthy cortisol levels keep fat evenly distributed and limbs proportionate.

• ~22%: Truncal Fat (normal baseline range)
• 0/10: Facial Fat Score (no moon face)
• 100%: Limb Muscle Mass (normal proportional mass)
• Diurnal: Cortisol Pattern (normal circadian rhythm)

Normal cortisol physiology

Cortisol peaks each morning, falls overnight, regulates metabolism normally.

Even fat and muscle balance

Fat is distributed evenly; limb muscle mass stays proportional to trunk.

Chronic Cortisol Excess Begins Reshaping Tissue

Excess cortisol promotes central lipogenesis while breaking down peripheral tissue.

• Elevated: Cortisol Level (chronic hypercortisolism)
• Central/Facial: Lipogenesis Site (preferential fat deposition)
• Peripheral: Catabolic Effect (muscle & limb fat breakdown)
• 0–3 mo: Onset Window (early redistribution phase)

Dual action of excess cortisol

Cortisol favors fat storage centrally, catabolism peripherally, simultaneously.

Why fat depots differ

Central adipocytes are more cortisol-sensitive than limb adipocytes.

Truncal Obesity Develops Over Months

Visceral and subcutaneous trunk fat expands as cortisol exposure continues.

• 45–60%: Truncal Fat (rising steadily)
• ↑ Marked: Waist Change (central adiposity)
• ~85%: Limb Muscle Mass (early wasting begins)
• ~9 mo: Duration (mid-course exposure)

Truncal obesity mechanism

Cortisol upregulates lipoprotein lipase centrally, driving fat storage.

Limbs begin thinning

Peripheral muscle protein breakdown slowly accelerates with exposure.

Characteristic Redistribution Patterns Emerge

Facial fullness and a dorsocervical fat pad become clinically visible.

• 7–9/10: Facial Fat Score (moon face prominent)
• Present: Dorsocervical Pad (buffalo hump forming)
• ~65%: Truncal Fat (central obesity marked)
• ~70%: Limb Muscle Mass (visible thinning)

Moon face formation

Facial subcutaneous fat expands, rounding and widening the face.

Buffalo hump formation

Dorsocervical fat pad accumulates at the base of the neck.

Paradoxical Body Habitus — Central Obesity with Thin Limbs

Central obesity plus wasted limbs forms a pattern that raises clinical suspicion.

• ~78%: Truncal Fat (severe central obesity)
• 10/10: Facial Fat Score (full moon face)
• ~55%: Limb Muscle Mass (marked atrophy)
• Diagnostic Cue: Clinical Use (raises Cushing suspicion)

The paradoxical pattern

Central fat gain paired with limb wasting is visually distinctive.

Clinical significance

This body shape prompts screening for Cushing's syndrome.