Hepatic steatosis in Cushing's syndrome: a radiological assessment using computed tomography.
OBJECTIVE
Hepatic steatosis may occur in association with insulin resistance and obesity, two features commonly seen in Cushing's syndrome (CS). The aim of this report is to assess the prevalence of hepatic steatosis in patients with active CS using computed tomography (CT) and to identify any associations between hepatic steatosis, endocrine and biochemical variables and body fat distribution.


METHODS
We identified 50 patients with active CS in whom appropriate CT was available to allow measurement of liver and spleen attenuation. In 26 patients, abdominal fat measurements were also available. Serum markers of CS and liver function tests were recorded.


RESULTS
Ten of 50 patients had a liver-to-spleen CT attenuation ratio (L/S) of less than 1, indicating hepatic steatosis. There was a significant negative correlation between both liver attenuation and L/S ratio with total abdominal fat area, visceral fat area, the percentage of visceral fat and the visceral to subcutaneous fat ratio; the strongest negative correlation was found between visceral fat area and L/S ratio (r=-0.638, P<0.001, n=26). L/S ratio positively correlated with alkaline phosphatase levels (r=+0.423, P=0.044, n=23) but with no other serum marker of CS activity or liver enzyme.


CONCLUSIONS
We have demonstrated hepatic steatosis on CT in 20% of patients with active CS. The presence of hepatic steatosis was significantly correlated with total abdominal fat area and visceral fat area.
Rockall
A G
AG
Department of Diagnostic Radiology, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK. a.g.rockall@qmul.ac.uk
Sohaib
S A
SA
Evans
D
D
Kaltsas
G
G
Isidori
A M
AM
Monson
J P
JP
Besser
G M
GM
Grossman
A B
AB
Reznek
R H
RH
D000273:Adipose Tissue; D000328:Adult; D000368:Aged; D001823:Body Composition; D015897:Comorbidity; D003480:Cushing Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed