Candemir Burcu, Kisip Kadir, Akın Şafak, Sanal Hatice Tuba, Taşar Mustafa, Candemir Mustafa, Gülçelik Neşe Ersöz
Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, University of Health Sciences, Ankara, Turkey.
Gulhane Faculty of Medicine, Department of Radiology, University of Health Sciences, Ankara, Turkey.
Clin Endocrinol (Oxf). 2025 Apr;102(4):380-388. doi: 10.1111/cen.15194. Epub 2025 Jan 2.
Patients with mild autonomous cortisol secretion (MACS) are at increased risk of cardiometabolic outcomes, such as hyperglycemia, metabolic syndrome, and cardiovascular diseases. Nonalcoholic fatty liver disease (NAFLD) is also associated with increased cardiometabolic risk. We aimed to investigate the prevalence and predictors of NAFLD in metabolically healthy subjects with MACS.
Forty patients with MACS and 60 patients with nonfunctioning adrenal incidentaloma (NFAI) matched for age, gender, and body mass index were included. We excluded various diseases that may lead to NAFLD, such as diabetes, cardiovascular diseases, and liver disorders. Non-alcoholic fatty liver disease was evaluated with unenhanced abdominal computed tomography and noninvasive fatty liver indices.
Patients with MACS had lower mean liver attenuation values (Hounsfield units, HU) than those with NFAI (p = 0.001). Visceral adiposity index, hepatic steatosis index, and fatty liver index were higher in the MACS group than in the NFAI group (p = 0.009, p = 0.002, p = 0.023, respectively). However, there was no significant association between the mean liver HU value and these indices. There was a significant association between serum cortisol level after the 1 mg dexamethasone suppression test (DST) and mean liver HU value independent of other traditional risk factors in various models performed in multivariable linear regression analysis.
Our findings suggest that MACS is associated with an increased risk of NAFLD, and serum cortisol level after 1 mg DST is an independent predictor of NAFLD in patients with MACS.
轻度自主性皮质醇分泌（MACS）患者发生心脏代谢性结局的风险增加，如高血糖、代谢综合征和心血管疾病。非酒精性脂肪性肝病（NAFLD）也与心脏代谢风险增加相关。我们旨在调查MACS代谢健康受试者中NAFLD的患病率及预测因素。
纳入40例MACS患者和60例年龄、性别及体重指数相匹配的无功能肾上腺意外瘤（NFAI）患者。我们排除了各种可能导致NAFLD的疾病，如糖尿病、心血管疾病和肝脏疾病。采用腹部平扫计算机断层扫描和非侵入性脂肪肝指数评估非酒精性脂肪性肝病。
MACS患者的平均肝脏衰减值（亨氏单位，HU）低于NFAI患者（p = 0.001）。MACS组的内脏脂肪指数、肝脂肪变性指数和脂肪肝指数高于NFAI组（分别为p = 0.009、p = 0.002、p = 0.023）。然而，平均肝脏HU值与这些指数之间无显著关联。在多变量线性回归分析的各种模型中，1 mg地塞米松抑制试验（DST）后的血清皮质醇水平与平均肝脏HU值之间存在显著关联，且独立于其他传统风险因素。
我们的研究结果表明，MACS与NAFLD风险增加相关，1 mg DST后的血清皮质醇水平是MACS患者NAFLD的独立预测因素。
