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Liver Disease Diagnosis and Treatment / Pituitary Gland Disorders and Treatments · Journal article
Frontiers in Endocrinology · September 9, 2026
Encouraging direction, but not yet definitive.
In a cross-sectional cohort of 65 participants across the hypercortisolism spectrum, the Hepatic Steatosis Index (HSI) alone discriminated MRI-defined visceral adiposity (VAT >130 cm²) with an AUC of 0.82 and high specificity (93% PPV), whereas conventional anthropometric measures and other visceral fat indices did not. This suggests HSI may have exploratory potential as a non-imaging screening tool for occult visceral adiposity in hypercortisolism, but the findings are derived from a single cohort and require external validation.
Cross-sectional diagnostic accuracy study. 13 participants with active Cushing's disease, 12 with Cushing's disease in remission, 30 with mild autonomous cortisol secretion (MACS), and 10 healthy controls. Specific eligibility criteria and clinical setting not stated in abstract.. Intervention: Abdominal MRI with proton density fat fraction quantification and clinical index calculation (HSI, VAI, METS-VF).. Compared with: MRI-defined visceral adiposity (VAT >130 cm²) as the reference standard for diagnosis.. n = 65. Not stated..
VAT differed across hypercortisolism groups (p=0.02), highest in MACS at 230.8 [164.9–292.4] cm². HSI was the only index reaching significance for visceral adiposity discrimination (AUC 0.82, 95% CI: 0.68–0.96, p=0.002) at a cohort-derived cutoff of 39.25, with sensitivity 87% and positive predictive value 93%. METS-VF, BMI, and waist circumference did not discriminate visceral adiposity (all p≥0.1).
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians evaluating patients with hypercortisolism may consider HSI as an exploratory, non-imaging screening tool for visceral adiposity when MRI is unavailable, particularly in lean or non-obese patients where conventional anthropometry is less discriminative. However, this finding is from a single cohort with a derived cutoff and should not yet be adopted for clinical decision-making pending external validation in independent populations.
A cross-sectional validation study of moderate size showing HSI discriminates MRI-defined visceral adiposity in hypercortisolism with good specificity (AUC 0.82), but requires external validation and addresses a surrogate endpoint in a limited population.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians evaluating patients with hypercortisolism may consider HSI as an exploratory, non-imaging screening tool for visceral adiposity when MRI is unavailable, particularly in lean or non-obese patients where conventional anthropometry is less discriminative. However, this finding is from a single cohort with a derived cutoff and should not yet be adopted for clinical decision-making pending external validation in independent populations.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Objective Conventional anthropometric measures may inadequately capture metabolically relevant fat redistribution in hypercortisolism. We evaluated the discriminative performance of clinical indices (Hepatic Steatosis Index [HSI], Visceral Adiposity Index [VAI], Metabolic Score for Visceral Fat [METS-VF]) and anthropometric measures (body mass index [BMI], waist circumference) for MRI-defined visceral adiposity across the hypercortisolism spectrum. Design and methods In this cross-sectional study, 65 participants were included: 13 with active Cushing’s disease (CD), 12 with CD in remission, 30 with mild autonomous cortisol secretion (MACS), and 10 healthy controls. Abdominal MRI with proton density fat fraction separately quantified visceral (VAT), hepatic, and pancreatic fat. Index performance for visceral adiposity (VAT >130 cm²) was assessed among participants with hypercortisolism (n=55). Results VAT differed across groups (p=0.02), highest in MACS (230.8 [164.9–292.4] cm²). VAT was associated with HOMA-IR (r=0.5, p=0.009) and HbA1c (r=0.4, p=0.001) but not with circulating cortisol. Hepatic and pancreatic fat did not differ across groups; hepatic fat correlated with HOMA-IR and pancreatic fat with HbA1c, but neither with cortisol. HSI was the only index reaching significance for visceral adiposity (AUC 0.82, 95% CI: 0.68–0.96, p=0.002), at a cohort-derived cut-off of 39.25 (sensitivity 87%, positive predictive value 93%); METS-VF, BMI, and waist circumference did not (all p≥0.1). Among participants without obesity (BMI <30 kg/m², n=31), HSI classification remained associated with visceral adiposity (p=0.001). Conclusion In endogenous hypercortisolism, ectopic fat distribution was more closely associated with metabolic burden rather than cortisol levels. HSI may have potential as an exploratory screening adjunct for occult visceral adiposity, particularly in patients without obesity, pending external validation.
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