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Association of endogenous hypercortisolism with hepatic hemangiomas in cushing's disease: a retrospective cohort

Lanlan Zhao1, Jiao Liu1, Na Li2

  • 1Department of Endocrinology & Rare Diseases, The second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, China.

BMC Endocrine Disorders
|June 23, 2026
PubMed

Insights

Hepatic hemangioma (HH) is more common in Cushing's disease (CD) patients than silent corticotroph adenomas (SCA). Elevated cortisol levels are linked to HH, aiding early risk assessment.

Area of Science:

  • Endocrinology
  • Hepatology
  • Oncology

Background:

  • The relationship between endogenous hypercortisolism and hepatic hemangioma (HH) is not well understood.
  • Cushing's disease (CD) involves persistent endogenous hypercortisolism, while silent corticotroph adenomas (SCA) do not.

Purpose of the Study:

  • To compare HH prevalence in CD versus SCA patients.
  • To identify factors associated with HH in CD patients.

Main Methods:

  • Retrospective observational study of 96 CD and 219 SCA patients.
  • Propensity score matching (PSM) used to balance baseline characteristics.
  • Multivariate logistic regression, LASSO, and Firth-corrected likelihood regression analyzed HH predictors.

Main Results:

  • HH prevalence was significantly higher in CD patients (20.0%) compared to SCA patients (9.5%) post-PSM (P=0.024).
  • Elevated midnight cortisol and 24-hour urinary free cortisol were independently associated with HH in CD patients.
  • A predictive model showed excellent discrimination (AUC=0.982) and calibration for HH risk.

Conclusions:

  • Cushing's disease is associated with a higher prevalence of hepatic hemangioma.
  • Elevated cortisol levels are a key factor contributing to HH development in CD patients.
  • A validated predictive tool can assist in early risk assessment and clinical management of HH.
Abstract

Keywords:
CortisolCushing's diseaseHepatic hemangiomaPituitary neuroendocrine tumorSilent corticotroph adenoma

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