Endocrine Abstracts

Introduction: Liver Steatosis (LS) can be one of the metabolic complications of Cushing Syndrome (CS). The data on the impact of cortisol on liver function are very limited, according to one study the prevalence of LS in CS is 20%. However, the frequency seems to be much higher. Hepatic Steatosis Index (HSI) predicts LS based on ALT, AST, BMI, sex and co-existence of diabetes mellitus/impaired glucose intolerance. It can identify candidates for further liver examinations.

Objectives: To evaluate the prevalence of LS in patients with CS at the time of diagnosis by using HSI.

Methods: We analyzed retrospectively adult patients from the ERCUSYN, Krakow database with complete HSI data available. The HSI score was calculated using the following formula: 8×(ALT/AST)+BMI+2(if type 2 diabetes)+2(if female). Collected data were from the baseline CS diagnosis. Patients with score 36 or above were classified as highly likely to have LS. We compared the results with abdominal ultrasonography (USG), serum biomarkers and demographic factors.

Results: 82 out of 135 patients, aged 27–87 years, predominantly women (n=64), were eligible for the study. The etiology of CS was mostly pituitary (47), followed by adrenal (20) and ectopic cause (15). 81.7% patients, showed high HSI (82.8% of females, 77.8% of males). HSI was elevated in 85, 80 and 73 percent of patients with pituitary, adrenal and ectopic CS. 41% of patients with elevated HSI were obese. HSI was elevated among: 100% patients with confirmed liver steatosis on USG, 72% patients with normal USG and 78% patients who hadn’t have USG performed.

Conclusions: The prevalence of liver steatosis in active CS may be much higher than previously reported. Further investigations may show if patients with high risk of liver steatosis based on HSI and normal liver image on USG, may benefit from liver MRI in order to verify the diagnosis.