Investigating the role of cortisol and growth hormone in fatty liver
development: Fatty liver index in patients with pituitary adenomas
Max Planck Institute
of Psychiatry
German Research Institute of Psychiatry
Matthias K. Auer, Günter K. Stalla, Mareike R. Stieg
RG Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
1
Purpose Non-alcoholic fatty liver disease (NAFLD) is a hallmark of the metabolic syndrome and has been shown to
be an independent predictor of cardiovascular mortality. Although glucocorticoids and growth hormone are known to
be implicated in its pathophysiology, it has only rarely been investigated in the context of patients with pituitary
insufficiency or former cortisol excess.
Results Although there was no difference in FLI between patients with NFPA and CD, we identified average daily hydrocortisone
(HC) intake in those with adrenal insufficiency to be an independent predictor of FLI even after adjusting for BMI and waist
circumference. In line, those with a FLI > 60 were also taking in average significantly more HC per day than those with a score FLI <
60 was also the best independent predictor for HbA1c and fasting glucose levels (both p = 0.001). Growth hormone deficiency and
replacement therapy were not associated with FLI in either group.
Methods Case-control study in patients with biochemically controlled Cushing's disease (CD) (N=33) and nonfunctioning pituitary adenomas (NFPA) (N=79). NAFLD was estimated by calculating the fatty liver index (FLI) that Conclusions While HC dosage affects FLI as an estimate of NFLD in patients with CD and NFPA, the benefit of GH replacement
shows high accordance with imaging methods for assessing NFALD. The FLI includes BMI, waist circumference, still needs to be determined. In contrast to reports in CD patients with active disease, NAFLD in those with biochemical control was
not different from NFPA patients.
GGT and triglyceride levels for its calculation. A score >60 has a specifity of ~80 % for detecting NAFLD.
Cushing's
NFPA
disease
Cushing's
NFPA
p
disease
N
% N %
Male
1
Female
43 54.4 <0.001
3
32 97
36 45.6
Mean SD MeanSD
50.3 13.4 61.6 14.5
Age (years)
Pituitary function
Pituitary insufficiency
no
yes
Number of pituitary
deficiencies
Secondary adrenal
insufficiency
10 30.3
23 69.7
0
1
2
3
4
8
9
5
7
3
no
yes
Total adrenal
insufficiency*
no
yes
Average daily
hydrocortisone
intake (mg) (range
10-30mg)
Secondary
hypothyroidism
GHD
no
yes
no
yes
treated
untreated
Untreated GHD
no
yes
18 22.8
61 77.2
24.2
27.3
15.2
21.2
12.1
15
11
8
18
27
24 72.7
9 27.3
19
13.9
10.1
22.8
34.2
43 54.4
36 45.6
*
Anthropometry
Weight (kg)
BMI (kg/m²)
0.04
Waist (cm)
Systolic blood
pressure
(mmHg)
Diastolic blood
n.s. pressure
(mmHg)
Laboratory
55 Predictors of cardiovascular risk factors
3 Predictors of the fatty liver index
2 General characteristics of study population (N=112)
β
p
Confidence
interval (CI) (95.0%)
Lowest
Highest
HDL
2 n.s.
ECE 2016
β
Not pretreated**
Indep.
p-value variable
S.E.
FLI -0.262 0.118 0.032
Female
-22.535
sex
HC dosage 1.804
-39.298
-2.006
0.072
3.536
Systolic
blood
pressure
(mmHg)
0.859 0.042
Age 0.851 0.180 < 0.001
BMI
Mean S.E. Mean S.E.
Fasting glucose
87.3 2.8 84.1 1.7
0.07 (mg/dl)
Hba1c (%)
5.5 0.1 5.3 0
Total cholesterol
212.3 8.2 216.4 5
(mg/dl)
HDL(mg/dl)
63.6 3.8 59.5 2.2
LDL(mg/dl)
136.7 7.2 140.1 4.3
0.07 Triglycerides
145.3 15.9 141.9 10.1
(mg/dl)
Gamma-GT (U/l) 32.8 5.7 32.8 5.7
43 54.4
0.072 ALAT(U/l)
23 2.5 26.2 1.5
36 45.6
ASAT(U/l)
22.4 1.7 26.6 1
AP(U/l)
64.5 4.2 69.3 2.6
Mean S.E. MeanS.E.
19 57.6
14 42.4
n.s.
n.s.
n.s.
n.s.
n.s.
Waist
p
6
FLI -0.356 0.134 0.013
Age
0.426 0.152 0.001
Sex -13.622 4.488 0.012
Model 2**
HC dosage
S.E.
8.971 0.016
128.8 3.1 136.9 1.8 n.s.
85.2 1.9 85.2 1.1 n.s.
β
GHD 18.567 8.435 0.037
1.124
4.087
0.296
0.451 0.017
0.212
2.036
3.023
0.028
5.151
0.563
0.526 < 0.001
0.132 0.031
* Regression analysis included age, sex, diagnosis, untreated
GHD, adrenal insufficiency, untreated hypogonadism, secondary
hypothyroidism
**+ BMI + Waist circumference
Diastolic
blood
pressure
(mmHg)
Sex -10.18 2.723 0.001
Sex -7.852 2.731 0.010
HbA1c
(%)
FLI 0.008 0.002
FLI
0.235 0.064 0.001
FLI
0.235 0.064 0.001
0.001
Age 0.014 0.005 0.006
Sex 0.348 0.156 0.031
4 Predictors for a fatty liver index > 60
Fasting
glucose
(mg/dl)
n.s.
FLI 0.230 0.068 0.002
* Regression analysis The predictive variables were age, sex, diagnosis, FLI,
n.s.
n.s.
n.s.
n.s.
hypogonadism, HC dosage and untreated GHD and IGF-1.
** Patients excluded taking anti-hyperglycemic drugs (for HbA1c, fasting glucose),
antihypertensive medication (for systolic, diastolic BP), anti-hyperlipidemic drugs
(for total cholesterol, HDL, LDL), respectively. FLI = Fatty liver index
n.s. FLI
20.4 3.3 18.7 5.7
Mean FLI
N
%
N
15 45.5
18 54.5
%
47 59.5
32 40.5
FLI < 60
FLI > 60
n.s.
IGF1 (ng/dl)
23 69.7
10 30.3
26 32.9
16 20.3 n.s.
118.7 14.3 141 7.8 n.s.
Patients with CD were significantly younger
and included more women as expected by the
19 57.6 26 32.9
0.02
general epidemiology of the diseases
14 42.4 53 67.1
7 21.2
7 21.2
26 78.8
7 21.2
66
N % N %
47.6 6 49.1 3.6 n.s.
29 36.7
24 30.4
55 69.6
29 36.7
n.s.
n.s.
Additionally, in the NFPA group more patients
were suffering from GHD.
* ANCOVA including age and sex
Model with FLI (Used as a dichotomic variable; FLI ≥60 and
FLI <60)*
β
S.E. p-value
Confidence
interval (CI) (95.0%)
Model
Sex
(male)
HC
dosage
2.758
0.201
0.845
0.082
0.027
0.02
0.013
1.041
0.768
0.587
* Regression analysis Including age, sex, diagnosis,
hypogonadism, secondary hypothyroidism, adrenal
insufficiency, untreated GHD
This study was in part supported by an unrestricted research grant from Pfizer (WI194219)
891-EP
Dep.
Indep.
variable* variable
Model 1*
75 3.3 78 2.8 n.s.
26.6 1 27.8 0.6 n.s.
94
p
Model
Mean S.E. Mean S.E.
94.2 3.1
S.E.
All patients
Pituitary - Clinical
Matthias K.
Poster
presented at:
Individual analysis of the components of the fatty liver index
Model for fasting glucose
Model for Hba1c
β
S.E. p value
Model 1*
β
S.E. p value Model 1*
18.988 4.297
GGT
0.400 0.155
0.016
GGT
< 0.001
Model 2**
GGT
0.342
0.124
0.012
Model 2**
GGT
18.833 3.237
< 0.001
Regression analysis The predictive variables were age, sex, diagnosis, overt
hypogonadism, HC dosage and
untreated GHD, triglycerides, BMI, gamma-GT (GGT), waist circumference
*All patients **Only patients without anti-diabetic drugs