MAFLD in Patients with Cushing’s Disease Is Negatively Associated with Low Free Thyroxine Levels Rather than with Cortisol or TSH Levels

Abstract

Purpose. This study aims to analyze the clinical characteristic of metabolic associated fatty liver disease (MAFLD) in patients with active Cushing’s disease (CD) and determine associations of thyroid hormones with MAFLD. Methods. Patients with active CD were included in this cross-sectional study. All subjects were assessed for hepatic steatosis by abdominal ultrasonography and thyroid functions. Demographic and clinical characteristic parameters were collected for correlation analysis and logistic analysis. Results. 290 individuals with active CD were included in Huashan hospital from January 2014 to February 2022. We found that the prevalence of CD with MAFLD was 33.79%. The MAFLD group had a lower level of FT4 and a higher level of FT3/FT4 but no difference in levels of cortisol, 24 h UFC, TSH, TT4, TT3, and FT3. Correlation analysis showed positive associations of TSH, TT4, TT3, FT3, and FT3/FT4 with BMI. In age-, BMI-, sex-, cortisol-, and 24 h UFC-adjusted analysis, FT4 was independently associated with MAFLD in patients with CD. This association remained similar even after adjusting for the presence of metabolic syndrome components. Conclusion. Lower FT4 levels were associated with higher risk of MAFLD in patients with CD. FT4 may be used as a helpful indicator to predict MAFLD and provide novel ideas for the treatment of MAFLD in patients with CD in the future.

Role of Glucocorticoids in Metabolic Dysfunction-Associated Steatotic Liver Disease

“…In the same study, hepatic steatosis was more common in patients with ACTH-dependent Cushing’s syndrome than in those with ACTH-independent Cushing’s syndrome (27.6% vs. 18.2%, respectively), as well as in men than in women (33.2% vs. 26.0%, respectively) [ 60 ], although the latter difference was smaller than that observed in the previously mentioned Chinese study [ 68 ]. In a third Chinese study, hepatic steatosis on ultrasonography was present in 33.8% of patients with Cushing’s syndrome [ 71 ]. Interestingly, MASLD was also common in children with iatrogenic Cushing’s syndrome; specifically, MASLD was observed in almost half (5 of 11) children on treatment with oral or topical GC [ 72 ].…”