Relation between cortisol and metabolic dysfunction-associated steatotic liver disease: A dog chasing its tail

Table 1 Studies reporting prevalence of metabolic dysfunction-associated steatotic liver disease in patients with endogenous hypercortisolism

Ref.	Number of patients	Patients	MASLD criteria for diagnosis	Results	Additional findings and comments
Marengo et al[33]	49	27 CS; 10 adrenal adenoma; 6 adrenal hyperplasia; 1 ACC; 5 ectopic ACTH	Reported on ultrasound. TC (liver/spleen attenuation ratio)	26% of liver steatosis	MASLD appears to be more frequent in adrenal adenomas. Data on follow up are limited from the small number of patients
Rockall et al[32]	50	50 CS	Liver/spleen attenuation ratio	20% of liver steatosis	The author showed a correlation between hepatic steatosis and abdominal fat area and visceral fat area
Zhou et al[10]	1652	905 CD; 16 ACC; 30 primary pigmented nodular adrenocortical disease; 346 adrenal adenomas; 102 bilateral macronodular adrenal hyperplasia; 98 ectopic; 20 unknown	ICD10 codes	24.5% liver steatosis	The study is retrospective and based on ICD10 codes and therefore there is high risk of bias
Candemir et al[35]	40	40 metabolically healthy MACS	Liver/spleen attenuation ratio	25%	The authors found that DEX1 response is a predictor of MASLD
Yu et al[34]	159	100 MACS; 59 CS	Liver/spleen attenuation ratio	57% in MACS; 66% CS	TyG-index, and HOMA-IR are critical markers in the development of nonalcoholic fatty liver disease in patients with excess cortisol

MASLD: Metabolic dysfunction-associated steatotic liver disease; CS: Cushing’s syndrome; ACC: Adrenocortical cancer; ACTH: Adrenocorticotropic hormone; CD: Cushing’s disease; MACS: Mild autonomous cortisol secretion; TC: Total cholesterol; DEX 1: 1 milligram dexhametasone suppression test; TyG: Triglyceride glucose; HOMA-IR: Homeostasis model assessment of insulin resistance.