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

PURPOSE: The association between persistent endogenous hypercortisolism and hepatic hemangioma (HH) remains unclear. This study compared the prevalence of HH between patients with Cushing's disease (CD) and silent corticotroph adenomas (SCA) and explored factors associated with HH in CD patients.

METHODS

This retrospective observational study included 96 CD patients and 219 SCA patients treated between May 2015 and December 2025. Demographic, laboratory, and imaging data were collected. Propensity score matching (PSM) balanced baseline characteristics. HH was diagnosed by contrast-enhanced abdominal CT. Multivariate analyses, including logistic regression, LASSO regression, and Firth-corrected likelihood regression, were performed. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

RESULTS

After PSM, HH prevalence was higher in CD patients than in SCA patients (20.0% vs. 9.5%, P = 0.024). Among CD patients, elevated midnight cortisol (OR = 1.402, 95% CI: 1.078-2.031, P = 0.010) and increased 24-hour urinary free cortisol (OR = 1.013, 95% CI: 1.006-1.023, P < 0.001) were independently associated with HH. The predictive model demonstrated good discrimination (AUC = 0.982, 95% CI: 0.961-1.000) and acceptable calibration, with potential clinical utility supported by DCA.

CONCLUSION

HH was more prevalent in patients with Cushing's disease than in those with silent corticotroph adenomas. Elevated cortisol levels may be an important factor associated with HH. This study offers a predictive tool to support early risk assessment and clinical management.

CLINICAL TRIAL NUMBER: Not applicable.