Prevalence of Metabolic Dysfunction Associated Steatotic Liver Disease in Craniopharyngioma Patients Using Non-Invasive Investigations

Abstract Introduction: 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. Methods: 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. Results: MASLD was present in 62.5% (USG) and 66.7% (CAP) of patients. Despite a mean BMI