Yu Peng, Yuan Haoyue, Li Xiaomu, Chen Hong
Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Endocrinology and Metabolism, Shanghai Geriatric Medical Center, Shanghai, China.
Endocrine. 2025 Jan;87(1):334-343. doi: 10.1007/s12020-024-04043-4. Epub 2024 Sep 25.
To evaluate liver fat content in patients with non-functional adrenal incidentalomas (NFAI), mild autonomous cortisol secretion (MACS), and Cushing's syndrome (CS), and assess its relationship with cortisol levels.
This cross-sectional study used retrospective data from 103 NFAI patients, 100 MACS (serum cortisol after a 1-mg dexamethasone test >50 nmol/L), and 59 with CS. Abdominal CT scans measured hepatic and splenic CT values to calculate the liver-to-spleen (L/S) ratio. Metabolic indicators including fasting plasma glucose (FPG), LDL-c, HDL-c, HbA1c, etc were measured. Mediation analysis was used to explore the indirect effects of metabolic traits on the cortisol-liver fat relationship.
Patients included 103 NFAI, 100 MACS, and 59 CS. MACS patients had higher NAFLD prevalence (57%) than NFAI (26.2%, p < 0.001) but lower than CS (66.1%, p < 0.001). MACS and CS were associated with NAFLD (OR 3.83 and OR 5.73, p < 0.01), adjusted for age, body mass index (BMI), and covariates. Midnight serum cortisol correlated with L/S ratio (p < 0.001). HbA1c and Triglyceride-glucose index (TyG) mediated 24.5% and 49.5% of the cortisol and L/S ratio association, respectively. FPG, HbA1c, HDL-c, and TyG mediated the association between MACS or CS and the L/S ratio. Homeostasis model assessment of insulin resistance (HOMA-IR), fructosamine, and triglycerides mediated for MACS, while alkaline phosphatase did so for CS. Total cholesterol, LDL-c, ALT, AST, γ-GT, insulin, and uric acid did not mediate the association.
MACS and CS are linked to significant metabolic disturbances, including increased liver fat and impaired glucose and lipid metabolism, contributing to fatty liver.
评估无功能肾上腺偶发瘤（NFAI）、轻度自主性皮质醇分泌（MACS）和库欣综合征（CS）患者的肝脏脂肪含量，并评估其与皮质醇水平的关系。
这项横断面研究使用了103例NFAI患者、100例MACS患者（1毫克地塞米松试验后血清皮质醇>50 nmol/L）和59例CS患者的回顾性数据。腹部CT扫描测量肝脏和脾脏的CT值以计算肝脾比（L/S）。测量包括空腹血糖（FPG）、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-c）、糖化血红蛋白（HbA1c）等代谢指标。采用中介分析来探讨代谢特征对皮质醇与肝脏脂肪关系的间接影响。
患者包括103例NFAI、100例MACS和59例CS。MACS患者的非酒精性脂肪性肝病（NAFLD）患病率（57%）高于NFAI患者（26.2%，p<0.001），但低于CS患者（66.1%，p<0.001）。在调整年龄、体重指数（BMI）和协变量后，MACS和CS与NAFLD相关（OR分别为3.83和5.73，p<0.01）。午夜血清皮质醇与L/S比相关（p<0.001）。糖化血红蛋白（HbA1c）和甘油三酯-葡萄糖指数（TyG）分别介导了皮质醇与L/S比关联的24.5%和49.5%。FPG、HbA1c、HDL-c和TyG介导了MACS或CS与L/S比之间的关联。胰岛素抵抗稳态模型评估（HOMA-IR）、果糖胺和甘油三酯介导了MACS与L/S比的关联，而碱性磷酸酶介导了CS与L/S比的关联。总胆固醇、LDL-c、谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（γ-GT）、胰岛素和尿酸未介导这种关联。
MACS和CS与显著的代谢紊乱有关，包括肝脏脂肪增加以及糖脂代谢受损，进而导致脂肪肝。
