Purpose <p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is commonly associated with obesity, insulin resistance, and type 2 diabetes mellitus (T2DM). Cushing’s syndrome (CS), defined by chronic hypercortisolism, shares overlapping metabolic features with MASLD. However, the relationship between CS and MASLD remains underexplored. This study aimed to investigate the prevalence of hepatic steatosis and fibrosis in patients with CS using FibroScan and to examine their relationship with clinical and metabolic parameters.</p> Methods <p>This cross-sectional study included 44 patients with endogenous CS, along with 52 age-, sex-, and BMI-matched controls and 44 age- and sex-matched controls. Hepatic steatosis and fibrosis were assessed by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) using vibration-controlled transient elastography.</p> Results <p>MASLD was present in 56.8% of CS patients, with moderate-to-severe steatosis in 47.7%. CAP and LSM values were comparable between CS and metabolically matched controls, but CAP was higher than in healthy controls. CAP positively correlated with body mass index (BMI), waist circumference, triglycerides, and 24-hour urine cortisol (UFC), and negatively with growth hormone. LSM was positively correlated with BMI and GGT. No correlations were found with fasting glucose, HbA1c, or serum cortisol. Multivariate analysis identified UFC as an independent predictor of CAP, while BMI and GGT independently predicted LSM.</p> Conclusion <p>Hepatic steatosis was frequent in CS and similar to metabolically matched individuals, but more common than in healthy controls. UFC, BMI, and waist circumference contribute to liver fat accumulation, while diabetes was not an independent predictor of steatosis in CS.</p>