MALFD prevalence in a cohort of patients with Cushing´s Disease
P. Remon-Ruiz*a (Mr), A. Piñara (Ms), E. Venegas-Morenoa (Mrs), E. Dios-Fuentesb (Mrs), D. Canoa (Dr), M. Romero-Gomeza (Dr), A. Soto Morenoa (Dr)
a Virgen del Rocio University hospital, Seville, SPAIN ; b Virgen del Rocio University hospital, Sevile, SPAIN
Cushing's disease produces a large number of metabolic morbidity (obesity, high blood pressure, type 2 diabetes, osteoporosis). Although curing the disease resolves or improves most of these sequelae, there are some of them for which we have very little information. One of them is metabolic-associated fatty liver disease (MAFLD). There are few studies that have assessed the prevalence of MALFD in patients with cured or active Cushing's disease, whose prevalence is estimated at around 20% in patients with active Cushing's syndrome.
MATERIAL AND METHODS
Cross-sectional descriptive study. We included 58 patients with Cushing's disease from our cohort of patients who underwent a Fibroscan to analyze the degree of hepatic steatosis (CAP measured in dB/m) and liver fibrosis (fibrosis measured in kPa). Biochemical algorithms of liver steatosis and fibrosis were assessed. Clinical variables related to the disease were assessed in order to analyze their possible implication in the persistence of MAFLD.
7 (12.1%) men and 51 (87.9%) women. Median age 51.5 [43-60] years with 9.3 [3.7-18] years of follow-up.
39 (67.2%) cured and 19 (32.8%) non-cured. Median years of hypercortisolism was 2.13 [0.76-5.17] years. 26 (44.8%) showed any pituitary defficiency, 18 (31%) ACTH defficiency, 7 (12.1%) sex hormones defficiency and 16 (27.6%) thyroid.
Metabolic morbidities were, obesity in 28 (48.3%) patients, type 2 DM 16 (27.6%), HBP 29 (50%), dyslipemia 29 (50%) and 4 (6.9%) chronic renal disease.
39 (67.2%) patients showed any degree of MAFLD with a median CAP of 266 [222-288] db/m. 2 (3.4%) patients were diagnosed with liver fibrosis (kPa compatible with F3-F4).
MAFLD was associated with obesity, time of hypercortisolism, curation, type 2 DM and hypertrigliceridemia.
The prevalence of MAFLD in patients with Cushing's disease is high and higher than described in previous studies.
Hepatic steatosis is associated with variables related with the metabolic syndrome and the curation of Cushing´s disease. It is postulated that despite metabolic control, there is an increased risk of hepatic steatosis in uncured patients.
A low percentage of liver fibrosis has been observed compared to the degree of fibrosis.
The author has declared no conflict of interest.