Fatty liver disease along Cushing’s syndrome evolution

Abstract Introduction The clinical manifestations of Cushing's syndrome are variable, but an important number of patients present a metabolic syndrome, strongly associated with hepatic steatosis. The aim of this study was to determine the prevalence of Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) at the diagnosis of Cushing's syndrome. Methods We conducted a single-center retrospective study at Angers Hospital (France) between 2010 and 2020. Forty-nine patients followed for Cushing's syndrome with available abdominal imaging at diagnosis were included. A mean liver/spleen (L/S) density ratio < 1 on CT scan was diagnostic of hepatic steatosis. Simple clinicobiological scores predictive of hepatic fibrosis (FIB4, NAFLD Fibrosis Score and e-lift) were calculated for patients with hepatic steatosis. Results Thirteen of the 49 patients (26.5%) had hepatic steatosis at diagnosis of Cushing's syndrome. All 13 had MASLD. These patients had a higher prevalence of type 2 diabetes and higher triglyceride levels in multivariate analysis. There was no difference according to the intensity or duration of Cushing's syndrome. Among the 13 patients with MASLD, 2 (15.4%) had a significant fibrosis predictive score. Of the 4 patients with follow-up imaging after remission of Cushing's syndrome, 3 had remission of steatosis between 1 and 5 years after remission of Cushing's syndrome. No patient without MASLD at diagnosis had a worsening L/S ratio after remission. Conclusion We estimated the prevalence of hepatic steatosis at the diagnosis of Cushing's syndrome at 26.5%. The presence of metabolic factors was associated with the occurrence of hepatic steatosis