The Endocrine Truth Behind Buffalo Back Obesity: In-Depth Analysis of the Relationship Between Increased Adrenal Cortisol and Central Obesity
"Buffalo back obesity" refers to a person who is so obese that they resemble a buffalo. There is a stark contrast between their limbs and torso. Their limbs are very thin; looking at them alone, you would never guess they are obese, and would mistake them for a slender person. However, looking at their torso reveals a surprising contrast: why are their hands and feet so small, while their body is so large, with broad shoulders, a protruding front and back, and a round, full face? They truly resemble a buffalo. Hence the term "buffalo back obesity."
Buffalo hump obesity, also known as Cushing's disease or "hyperadrenocorticism," is caused by excessive cortisol secretion from the adrenal glands. The adrenal glands are extremely important endocrine glands in the human body. Humans have two kidneys and two adrenal glands. Removing the adrenal glands would severely disrupt the metabolism of sugars, proteins, and fats, immediately lowering the body's resistance and potentially leading to death within a short period. This underscores the crucial importance of the adrenal glands.
The adrenal glands secrete various hormones. One of these hormones is called glucocorticoid. This hormone is crucial for regulating glucose. It inhibits glucose consumption, causing blood sugar to rise. It also antagonizes insulin. Excessive secretion of glucocorticoids can lead to elevated blood sugar and diabetes. Conversely, insufficient secretion of glucocorticoids can result in hypoglycemia.
Furthermore, adrenal glucocorticoids are also crucial for fat metabolism. They can reduce fat tissue in the limbs while increasing fat in the abdomen, face, shoulders, and back. Long-term excessive secretion of adrenal glucocorticoids can lead to central obesity, characterized by thin limbs and a large body. Additionally, this hormone promotes protein breakdown, increasing blood amino acid levels and providing raw materials for hepatic gluconeogenesis. It promotes the gluconeogenesis process, increases liver glycogen reserves, and inhibits glucose consumption, thus raising blood sugar levels. Therefore, individuals with buffalo hump obesity may have a predisposition to diabetes.
Furthermore, individuals with buffalo hump obesity may also have a tendency towards hypertension, osteoporosis, cardiovascular and cerebrovascular diseases, and sexual dysfunction. According to data, buffalo hump obesity is more common in middle-aged women. However, it is generally a chronic condition. Due to its slow progression, patients may be less vigilant, as in the early stages, apart from slight obesity, there may be no symptoms at all. Some patients, upon discovering their obesity, try to lose weight through exercise or dieting, but the results are often minimal because they haven't sought appropriate treatment.
As the disease progresses to its middle and late stages, in addition to the increasingly obvious buffalo-like morphology, diabetes, hypertension, or cardiovascular and cerebrovascular diseases may also develop. The condition becomes complex and difficult to treat. Therefore, if symptoms such as stunted limbs and gradually enlarging body are observed, timely treatment is necessary. From a modern medical perspective, the kidneys and adrenal glands belong to the urinary and endocrine systems, respectively; from a traditional Chinese medicine perspective, there is no distinction between the kidneys and adrenal glands.
In Traditional Chinese Medicine (TCM), the term "kidney" also encompasses the function of the adrenal glands. Therefore, hypercortisolism or excessive adrenal cortex secretion falls under the category of "kidney fire." However, this fire is abnormal, hence it is called "evil fire of the kidneys." Treatment should focus on clearing and purging this evil fire. Traditional Chinese medicine believes this condition is related to excessive liver and kidney fire, liver yang hyperactivity, and liver and kidney yin deficiency, leading to evil fire disturbing the kidneys. Therefore, clinically, treatments may also involve calming the liver and suppressing yang, nourishing the liver and kidneys, and purging liver and kidney fire.