Endocrine Abstracts

Introduction: The most common etiology of endogenous Cushing’s syndrome (CS) is Cushing’s disease (CD). Patients with CS also represent a model of patients with metabolic syndrome (MetS) with associated increased cardiovascular morbidity and mortality. Insulin resistance and obesity, two major characteristics of CS, lead to the accumulation of triglycerides within hepatocytes and formation of fatty liver in these patients.

Aim: To evaluate the prevalence of metabolic syndrome and fatty liver and the importance of using lipid accumulation product (LAP) and fatty liver index (FLI) in patients with CD.

Material and methods: We conducted a cross-sectional study analyzing electronic medical histories of 52 patients (41 women, 11 men) diagnosed with CD (33 microadenomas and 19 macroadenomas) treated from 2009 to 2019. Mean age 50.5±13.5 years and body mass index (BMI) 29.3±5.8 kg/m².

Results: MetS defined by NCEP ATP III was present in 63.5% (n= 33) of patients with CD. Ultrasound findings of fatty liver in a cohort of our patients with CD were present in 40.4% (n= 21) patients, while only 11.5% (n= 6) had elevated transaminases. Patients with CD and MetS were significantly older from patients with CD alone (52.6±13.2 vs. 44.3±12.8 years). Obesity was present in 41.3% while diabetes and glucose intolerance were present in 60% of patients. Prevalence of obesity was even higher in patients with diabetes (72.2% vs. 27.8%; P=0.007). Obese patients had significantly higher values of LAP (174.7±79.4 vs. 54.4±24.3 P<0.05) and FLI (29.3±29.5 vs. 1.5±1, P<0.05). Patients with CD and ultrasonographic features of fatty liver had statistically significant higher values of LAP than those with CD alone (142.6±9.6 vs 61.1±21.2, P=0.045), while their FLI values were not statistically different. Arterial hypertension was observed in as many as 82.4% of patients. In 96% of patients, some form of dyslipidemia was present.

Conclusion: Cushing’s disease is characterized by an unfavorable metabolic profile and grouping of cardiovascular risk factors in the large percentage of patients. Fatty lever extends this unfavorable metabolic phenotype. LAP but not FLI is a good surrogate marker of fatty liver in CD.