{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T01:43:31Z","timestamp":1782783811542,"version":"3.54.5"},"reference-count":35,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T00:00:00Z","timestamp":1696550400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft Project","doi-asserted-by":"publisher","award":["314061271:CRC\/Transregio 205\/1"],"award-info":[{"award-number":["314061271:CRC\/Transregio 205\/1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Else Kroener-Fresenius-Stiftung","award":["314061271:CRC\/Transregio 205\/1"],"award-info":[{"award-number":["314061271:CRC\/Transregio 205\/1"]}]},{"name":"Eva Luise und Horst Koehler Stiftung","award":["314061271:CRC\/Transregio 205\/1"],"award-info":[{"award-number":["314061271:CRC\/Transregio 205\/1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Glucocorticoid excess is a known risk factor for non-alcoholic fatty liver disease (NAFLD). Our objective was to analyse the impact of glucocorticoid replacement therapy on the development of NAFLD and NAFLD-related fibrosis and, therefore, on cardiovascular as well as hepatic morbidity in patients with adrenal insufficiency. Two hundred and fifteen individuals with primary (n = 111) or secondary (n = 104) adrenal insufficiency were investigated for hepatic steatosis and fibrosis using the fatty liver index (FLI), NAFLD fibrosis score (NAFLD-FS), Fibrosis-4 Index (FiB-4) plus sonographic transient elastography. Results were correlated with glucocorticoid doses and cardiometabolic risk parameters. The median dose of hydrocortisone equivalent was 20 mg daily, with a median therapy duration of 15 years. The presence and grade of hepatic steatosis and fibrosis were significantly correlated with cardiometabolic risk factors. We could not find any significant correlations between single, daily or cumulative doses of glucocorticoids and the grade of liver steatosis, nor with fibrosis measured via validated sonographic techniques. In patients with adrenal insufficiency, glucocorticoid replacement within a physiological range of 15\u201325 mg hydrocortisone equivalent per day does not appear to pose an additional risk for the development of NAFLD, subsequent liver fibrosis, or the cardiovascular morbidity associated with these conditions.<\/jats:p>","DOI":"10.3390\/jcm12196392","type":"journal-article","created":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T04:52:36Z","timestamp":1696827156000},"page":"6392","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Glucocorticoid Replacement for Adrenal Insufficiency and the Development of Non-Alcoholic Fatty Liver Disease"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5639-4537","authenticated-orcid":false,"given":"Gesine","family":"Meyer","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Medical Clinic 1, University Hospital, Goethe University Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Gruendl","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Medical Clinic 1, University Hospital, Goethe University Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Chifu","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetes Unit, Department of Medicine I, University Hospital Wuerzburg, 97080 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Hahner","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetes Unit, Department of Medicine I, University Hospital Wuerzburg, 97080 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Werner","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetes Unit, Department of Medicine I, University Hospital Wuerzburg, 97080 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Wei\u00df","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Medicine II, University Hospital Wuerzburg, 97080 Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Kienitz","sequence":"additional","affiliation":[{"name":"Endocrinology in Charlottenburg, 10627 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Quinkler","sequence":"additional","affiliation":[{"name":"Endocrinology in Charlottenburg, 10627 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Badenhoop","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Medical Clinic 1, University Hospital, Goethe University Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0662-6675","authenticated-orcid":false,"given":"Eva","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Institut for Biostatistics and Mathematic Modelling, Goethe University Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireen","family":"Friedrich-Rust","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Medical Clinic 1, University Hospital, Goethe University Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg","family":"Bojunga","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Medical Clinic 1, University Hospital, Goethe University Frankfurt, 60590 Frankfurt, Germany"},{"name":"Division of Hepatology, Medical Clinic 1, University Hospital, Goethe University Frankfurt, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.bpg.2014.07.008","article-title":"Non-Alcoholic Fatty Liver Disease, Obesity and the Metabolic Syndrome","volume":"28","author":"Dietrich","year":"2014","journal-title":"Best Pract. 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