Associations between liver histology and cortisol secretion in subjects with nonalcoholic fatty liver disease.
OBJECTIVE
To assess associations between the activity of hypothalamo-pituitary-adrenal (HPA) axis and liver histology in patients with nonalcoholic fatty liver disease (NAFLD).


METHODS
In a cross-sectional study, we enrolled 50 consecutive, overweight, NAFLD patients and 40 control subjects who were comparable for age, sex and body mass index (BMI).


METHODS
NAFLD (by liver biopsy), HPA axis activity (by 24-hour urinary free cortisol [UFC] excretion and serum cortisol levels after 1 mg dexamethasone), insulin resistance (by homeostasis model assessment: HOMA-IR), and metabolic syndrome (MetS) features.


RESULTS
NAFLD patients had markedly higher (P < 0.001) 24-h UFC (149 +/- 24 vs. 90 +/- 16 nmol/day) and postdex suppression cortisol concentrations (32 +/- 10 vs. 16 +/- 7 nmol/l) than controls. The MetS and its individual components were more frequent among NAFLD patients. The marked differences in urinary/serum cortisol concentrations that were observed between the groups were little affected by adjustment for age, sex, BMI, waist circumference, systolic blood pressure, triglycerides, homeostasis model assessment for insulin resistance score and presence of diabetes. Importantly, 24-h UFC and postdex cortisol concentrations strongly correlated to hepatic necroinflammatory grade (P < 0.01) and fibrosis stage (P < 0.001) among NAFLD patients. By logistic regression analysis, 24-h UFC (odds ratio (OR) 1.80, 95%CI 1.3-2.8) or postdex cortisol concentrations (OR 1.95, 95%CI 1.4-3.1) independently predicted the severity of hepatic fibrosis, but not necroinflammation, after adjustment for potential confounders.


CONCLUSIONS
These results suggest that NAFLD patients have a subtle, chronic overactivity in the HPA axis (that is closely associated with the severity of liver histopathology) leading to subclinical hypercortisolism that might be implicated in the development of NAFLD.
Division of Internal Medicine, Sacro Cuore Hospital, Negrar, VR, Italy. targher@sacrocuore.it
Giovanni
G
Targher
Lorenzo
L
Bertolini
Stefano
S
Rodella
Giacomo
G
Zoppini
Luciano
L
Zenari
Giancarlo
G
Falezza
D000367:Age Factors; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000378:metabolism; D005234:Fatty Liver / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood / Q000652:urine; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism; D012737:Sex Factors; D014280:Triglycerides / Q000097:blood
D014280:Triglycerides; D002784:Cholesterol; D006854:Hydrocortisone