Endocrinologist's crucial role in metabolic dysfunction-associated steatotic liver disease: a comprehensive review

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a widespread disorder strongly associated with metabolic conditions such as obesity, insulin resistance, and type 2 diabetes (T2D). The progression of MASLD, which can lead to severe complications like hepatic fibrosis and cirrhosis, is closely tied to cardiometabolic risks, including cardiovascular disease, and to liver-related cancers associated with metabolic dysfunction. Endocrinologists are uniquely positioned to detect MASLD early, particularly in individuals with metabolic risk factors such as T2D, polycystic ovary syndrome (PCOS), and thyroid dysfunction. While they may not routinely perform advanced diagnostic procedures, they play a critical role in identifying at-risk patients and collaborating with specialists for further evaluation, including the use of transient elastography to assess liver stiffness and fibrosis. By doing so, they help reduce the need for invasive procedures. Beyond screening and diagnosis, endocrinologists collaborate with hepatologists, cardiologists, and nutritionists to ensure a comprehensive, multidisciplinary treatment approach. Managing MASLD requires addressing both liver-specific conditions and broader metabolic dysfunctions through lifestyle interventions and pharmacological therapies. Recent studies highlight the potential benefits of medications, such as farnesoid X receptor (FXR) agonists and peroxisome proliferator-activated receptor (PPAR) agonists, when combined with lifestyle interventions such as modifying diet and engaging in more physical activity. This review highlights the pivotal role of endocrinologists in managing MASLD, focusing on their contributions to screening, diagnosis, and integrated care. It examines the complex interplay between hormonal regulation and both pharmacological and non-non-pharmacological treatment strategies, providing insights for enhancing clinical practice and improving patient outcomes through a comprehensive, multidisciplinary approach.