Endocrine Abstracts

JOINT3605

Introduction: Cushing’s syndrome (CS) presents with various metabolic disturbances including Metabolic Associated Fatty Liver Disease (MAFLD). Glucocorticoids contribute in MAFLD pathogenesis through insulin resistance, adipose tissue lipolysis and hepatic lipogenesis, decreased fatty acid β-oxidation, upregulation in hepatic expression of 11β-HSD1 and decreased activity of 5α-reductase. The aim of our study was to evaluate the prevalence of MAFLD in a cohort of CS patients before and after remission of hypercortisolemia.

Materials and Methods: This is a single-center retrospective study of 101 patients with CS. Their follow up was at the Department of Endocrinology of Evangelismos General Hospital in Athens between 2017 and 2023. MAFLD was estimated using the Hepatic Steatosis Index (HSI) and the Fatty Liver Index (FLI). Hepatic steatosis index >36 and Fatty Liver Index >60 were categorized with point 3 and indicated a high possibility of MAFLD. Demographic and clinical characteristics of patients were recorded.

Results: 101 patients (90 females) with CS were identified. Their mean age±SD at the time of CS diagnosis was 51±14 years. 44/101 (43.5%) were diagnosed with adrenal CS and 57/101 (56.4%) with pituitary CS. Their mean BMI±SD was 32±9 kg/m². At diagnosis 23/44 (52.3%) of adrenal CS and 17/57 (29.8%) of Cushing’s Disease (CD) patients had type 2 diabetes mellitus. 35/44 (79.5%) of adrenal and 31/57 (54.4%) of CD patients were hypertensive. An Hepatic Steatosis Index of 3 was estimated in 81/101 (80.2%), [34/44 (77.3%) with adrenal and 47/57 (88.5%) with CD]. A Fatty Liver Index of 3 was calculated in 68/101 (67.3%), [33/44 (75%) with adrenal and 35/57 (61.4%) with CD]. At last follow up 83/101 (82.2%) [38/44 (86.36%) with adrenal and 45/57 (78.9%) with CD] were in remission from hypercortisolemia. Their mean BMI was 26±6 kg/m². An Hepatic Steatosis Index of 3 was estimated in 56/101 (55.4%) [25/44 (56.8%) with adrenal and 31/57 (54.3%) with CD], while a Fatty Liver Index of 3 was calculated in 25/101 (24.7%), [10/44 (22.7%) with adrenal and 15/57 (26.3%) with CD]. MAFLD markers did not differ significantly between adrenal and CD patients and they improved significantly after remission of hypercortisolemia- for HSI, P-value:<0.01; for FLI, P-value:<0.01-. Therapeutic modality was not a significant prognostic factor.

Conclusion: We found a high prevalence of MAFLD in our cohort of CS patients based on HSI and FLI with no significant difference between adrenal and CD patients. Remission of hypercortisolemia improved significantly MAFLD and treatment modality was not a prognostic factor.