Prevalence of Metabolic Dysfunction Associated Steatotic Liver Disease in Craniopharyngioma Patients Using...

Craniopharyngiomas are rare intracranial tumors that, despite being histologically benign, cause significant long-term morbidity due to hypothalamic and pituitary involvement. Survivors often develop hypothalamic obesity and metabolic syndrome components, predisposing them to metabolic dysfunction-associated steatotic liver disease (MASLD)-a newly defined entity emphasizing metabolic risk factors over alcohol exclusion. Data on MASLD in endocrine populations like craniopharyngioma survivors, especially in India, remain scarce.

In this cross-sectional observational study, 48 adult craniopharyngioma survivors at a tertiary center in Northern India were evaluated using non-invasive tools for MASLD. MASLD was diagnosed in patients with hepatic steatosis (by USG or CAP ≥248 dB/m) and at least one cardiometabolic risk factor. Anthropometry, body fat analysis (via dual energy x-ray absorptiometry), liver ultrasound, FibroScan (CAP and LSM), and biochemical/metabolic markers including HOMA-IR, lipid profile, HbA1c, and FIB-4 were assessed. Hormonal profile was performed to identify pituitary deficiencies.

MASLD was present in 62.5% (USG) and 66.7% (CAP) of patients. Despite a mean BMI <25 kg/m² in most, 72.9% had elevated waist-hip ratio and 62.5% had body fat ≥30%, indicating significant central adiposity. MASLD was significantly associated with insulin resistance (P = 0.028), elevated HbA1c (P = 0.031), hypertriglyceridemia (P < 0.001), low HDL (P = 0.005), GH deficiency (P = 0.032), and low IGF-1. Advanced fibrosis (F3-F4) was noted in 6.3% by FibroScan.

MASLD and visceral adiposity are highly prevalent in craniopharyngioma survivors, driven by hypothalamic-pituitary dysfunction. Routine metabolic and hepatic screening, beyond BMI, and optimized endocrine care are vital to prevent long-term morbidity in this vulnerable population.