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.