AASLD guidance 2023
"Associated endocrine disorders
In addition to its strong association with obesity and other metabolic risk factors, higher rates of NAFLD have been reported in patients with hypothyroidism, hypogonadism, growth hormone (GH) deficiency, and polycystic ovarian syndrome (PCOS).
GH deficiency
GH and the primary mediator of its metabolic effects, insulin-like growth factor-1 (IGF-1), are important regulators of glucose and lipid metabolism, growth, body composition, and cellular regeneration.(199–202) GH deficiency is associated with body fat redistribution and increased visceral adipose tissue mass and can result in insulin resistance, hyperglycemia, hyperlipidemia, and NAFLD.(203) In a meta-analysis, IGF-1 levels were lower in patients with NAFLD and strongly associated with obesity and insulin resistance.(204) One cause of GH deficiency, panhypopituitarism, is associated with
Studies evaluating effects of GH replacement in subjects with GH deficiency and NAFLD have been small and uncontrolled. In a study of adults with hypopituitarism (n = 69), GH replacement reduced aminotransferases (n = 11 with NAFLD) and improved liver histology in NASH (n = 5 with paired biopsies).(205, 208) In another study, GH replacement (n = 12 subjects) reduced visceral fat and hepatic steatosis by magnetic resonance spectroscopy.(209) In patients with HIV, lipodystrophy, and NAFLD, tesamorelin, a GH-releasing hormone analog, which augments pulsatile GH secretion and increases IGF-1 without adversely affecting insulin sensitivity,(210) reduced liver fat.(211) Overall, the association between a disturbance in the GH axis and NAFLD is strongly linked to changes in visceral fat and insulin resistance, but screening is not recommended for all patients."
AASLD_practice_guidance_on_the_clinical_assessment.293.pdf