Hepatic steatosis in Cushing's syndrome: a radiological assessment using computed tomography

Abstract

Objective: Hepatic steatosis may occur in association with insulin resistance and obesity, two features commonly seen in Cushing's syndrome (CS). The aim of this report is to assess the prevalence of hepatic steatosis in patients with active CS using computed tomography (CT) and to identify any associations between hepatic steatosis, endocrine and biochemical variables and body fat distribution. Patients and measurements: We identified 50 patients with active CS in whom appropriate CT was available to allow measurement of liver and spleen attenuation. In 26 patients, abdominal fat measurements were also available. Serum markers of CS and liver function tests were recorded. Results: Ten of 50 patients had a liver-to-spleen CT attenuation ratio (L/S) of less than 1, indicating hepatic steatosis. There was a significant negative correlation between both liver attenuation and L/S ratio with total abdominal fat area, visceral fat area, the percentage of visceral fat and the visceral to subcutaneous fat ratio; the strongest negative correlation was found between visceral fat area and L/S ratio (r ¼ 2 0.638, P , 0.001, n ¼ 26). L/S ratio positively correlated with alkaline phosphatase levels (r ¼ þ0.423, P ¼ 0.044, n ¼ 23) but with no other serum marker of CS activity or liver enzyme. Conclusions: We have demonstrated hepatic steatosis on CT in 20% of patients with active CS. The presence of hepatic steatosis was significantly correlated with total abdominal fat area and visceral fat area.

Gene expression changes in subcutaneous adipose tissue due to Cushing's disease

“…To evaluate lipolysis in explants from these patients, we measured glycerol release from isolated subcutaneous adipose tissue and found a 3.1-fold elevation (PZ0.049 via Student's t-test). These data support previous studies that implicate elevated lipolysis (Kršek et al 2006) and higher rates of nonalcoholic fatty liver disease in Cushing's disease patients (Rockall et al 2003).…”

Mechanisms in endocrinology: Non-alcoholic fatty liver disease in common endocrine disorders

“…The prevalence of hepatic steatosis measured by liver/spleen attenuation on CT scanning was 20% in a cohort of 50 patients with Cushing's syndrome (73). Importantly, patients with NAFLD do not have 'mild Cushing's syndrome', although abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis have been described including increase in urinary free cortisol concentrations and a reduction in dexamethasone suppression of plasma cortisol (74,75).…”

Quantitative computed tomography of the liver in dogs submitted to prednisone therapy

“…This technique provides valuable information, which complements those obtained by conventional imaging diagnosis methods such as radiographic and ultrasonographic exams (Rockall et al, 2003;Nakamura et al, 2005;. The greatest advantage of CT for veterinary medicine according to some authors is the speed in which the exam is performed, reducing movement artifacts and minimizing anesthetic time, being a non-invasive and safe method.…”

“…Computed tomography (CT) exams present a broad variety of indications for dogs and cats, becoming an important tool for the establishment of several diagnoses (Smallwood and George, 1993;Rockall et al, 2003;Nakamura et al, 2005;Ohlerth and Sharf, 2007;. The evaluation of abdominal organs' radiodensity is widely performed in human patients (Leander et al, 2000;Tsujimoto et al, 2006, Kodama et al, 2007 and can be employed with high precision and reproducibility in animals, helping in the diagnosis of alterations in several organs (Ohlerth andSharf, 2007, Teixeira et al, 2007;Costa et al, 2010).…”