Endocrine aspects beyond insulin resistance in metabolic dysfunction associated steatotic liver disease

The description of endocrine systems involved in the pathophysiology of metabolic dysfunction associated steatotic liver disease (MASLD) has been essential to achieve a holistic understanding of all mechanisms contributing to hepatic injury. In this review, we approach these mechanisms from a different perspective, analyzing how they exert deleterious effects to varying degrees. Growth hormone plays a protective role, as supported by evidence, and its deficiency states are associated with hepatic fat accumulation. Regarding thyroid hormones and their hepatic function, we describe their mechanisms and how they contribute to maintaining metabolic health; conversely, their deficiency is consistently linked to the development of MASLD. Glucocorticoids, particularly in the context of excessive exogenous administration, have been widely demonstrated to induce not only hepatic metabolic dysfunction but also systemic alterations across multiple axes. Given their relevance, we also address mineralocorticoids, which, although less studied, exhibit specific roles in metabolic regulation. Similarly, prolactin is discussed for its involvement in insulin resistance. Finally, we examine sex hormones, whose systemic reduction directly impacts fatty acid metabolism within hepatocytes.