Work

Quantitative magnetic resonance imaging (MRI) evaluation of visceral and hepatic fat in Cushing’s syndrome: insights into cortisol-driven metabolic changes

Year: 2026

Type: article

Abstract: Objective: To quantify hepatic steatosis and visceral adiposity in active Cushing’s syndrome (CS) using magnetic resonance imaging (MRI), evaluate associations between hypercortisolism and MRI-derived fat metrics, and characterize the relationship between hepatic and visceral fat compartments. Subjects and methods: This retrospective cross-sectional study assessed 36 patients with biochemically confirmed active CS. Hepatic proton density, fat fraction, and visceral adipose tissue area were quantified using chemical-shift encoded MRI with semi-automated segmentation. Biochemical assessments included serum cortisol, adrenocorticotropic hormone, liver enzymes, and lipid profiles. Results: MRI-defined hepatic steatosis (fat fraction ≥6.25%) was identified in 69.4% (25/36) of patients. Those with steatosis exhibited higher serum cortisol levels (832.9 ± 347.8 vs. 581.2 ± 331.9 nmol/L, p = 0.049) and greater visceral adiposity (35.0 ± 8.0 vs. 23.9 ± 6.7 cm2, p < 0.001). Serum cortisol positively correlated with visceral fat area (r = 0.512, p = 0.001) and inversely correlated with liver signal intensity index (r = -0.424, p = 0.01). Visceral adiposity demonstrated a strong positive correlation with hepatic steatosis grade (r = 0.601, p < 0.001). Conclusion: Hepatic steatosis was highly prevalent in active CS and closely linked to hypercortisolism and visceral adiposity. These findings support a mechanistic coupling between central and ectopic fat accumulation. Integrated MRI-based fat quantification provides a non-invasive, radiation-free approach for refined cardiometabolic risk stratification in this high-risk population.

Source: Archives of Endocrinology and Metabolism

DOI: 10.20945/2359-4292-2026-0109

Authors: Rania Naguib, Marwa Ahmed Salah Ahmed, Sherif Mohamed Elsharkawi, Hany A. Elkattawy, Mohamed Ahmed Hassan, Hend Naguib

Institutions: Princess Nourah bint Abdulrahman University, Almaarefa University, Alexandria University, Zagazig University

Language: English

Topic: Pituitary Gland Disorders and Treatments

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funder: AlMaarefa University