Glucocorticoid -Induced Fatty Liver Disease

Glucocorticoids are commonly used for treatment of a variety of diseases. Moreover, these agents are often used at high pharmacological doses and for prolonged periods to time. It is well established that one of the important side effects of treatment with high doses of glucocorticoids is increased deposition of lipids in the liver and visceral fatty tissue; these are common findings in patients with Cushing’s disease. In this presentation, pathways of lipid deposition and removal from the liver will be discussed in some detail. Then, the effect of excess cortisol on each of the pathways will be explored with the aim of gaining a better understanding of the fatty liver condition. Role of 11β-hydoxysteroid dehydrogenases and the reversible conversion of cortisol to cortisone on intracellular levels of cortisol will be summarized. In addition, control of osteocalcin expression by glucocorticoids and the effect of this bone-derived hormone in the regulation of insulin sensitivity will be discussed. Finally, areas of needed research on usage and prevention of glucocorticoidinduced fatty liver disease will be explored.