Metabolic Dysfunction–Associated Steatotic Liver Disease in Endocrine Practice: Risk Assessment, Fibrosis Stratification, and Treatment Considerations

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects roughly 30% of adults globally, rising to 55%-70% in type 2 diabetes mellitus (T2DM) and 60%-75% in obesity. The 2023 multi-society Delphi consensus placed MASLD within metabolic medicine, yet most guidance still approaches the condition from a hepatology standpoint and gives little attention to endocrine clinical workflows. PubMed/MEDLINE, Scopus, and Web of Science were searched from January 2018 to March 2026, combining legacy and updated nomenclature with 3 keyword domains (endocrine/ metabolic context, noninvasive fibrosis assessment, and pharmacological agents), with priority given to multisociety guidelines and randomized controlled trials with histological endpoints. Metabolic dysfunction-associated steatotic liver disease shares bidirectional pathways with T2DM, obesity, polycystic ovary syndrome, and thyroid dysfunction, placing endocrine clinics in a natural first-contact position. Non-invasive fibrosis triage with fibrosis-4 index followed by transient elastography or the Enhanced Liver Fibrosis test fits routine endocrine workflows; semaglutide, tirzepatide, pioglitazone, and resmetirom now have phase 2 or 3 histological data for metabolic dysfunction-associated steatohepatitis resolution or fibrosis improvement. Treatment prioritization across dominant endocrine- metabolic phenotypes is offered as a conceptual framework rather than a validated algorithm. Endocrine clinics are an underused setting for earlier identification of MASLD-related hepatic risk; non-invasive fibrosis assessment is feasible in selected high-risk patients, and the dominant metabolic comorbidity profile can guide treatment choices. The frameworks offered here are practical proposals, not replacements for society recommendations, and require prospective implementation studies in endocrine outpatient cohorts, including Turkish and regional populations.

Cite this article as: Yakut M, Berber K. Metabolic dysfunction–associated steatotic liver disease in endocrine practice: risk assessment, fibrosis stratification, and treatment considerations. Endocrinol Res Pract. Published online September 1, 2026. doi: 10.5152/erp.2026.26984.