Objective: This narrative review summarizes current evidence regarding hormonal disturbances associated with metabolic dysfunction-associated fatty liver disease in children. Focus was given to thyroid function, insulin sensitivity, gonadal hormones in boys, and vitamin D levels in relation to hepatic and metabolic abnormalities. Materials and Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted for literature published between January 2015 and June 2025. Studies included children aged 0–18 years with confirmed metabolic dysfunction-associated fatty liver disease based on imaging, histological, or biochemical criteria. Eligible articles reported data on at least one hormonal axis and included original research, meta-analyses, or high-quality narrative reviews. Adult-only studies, case series with fewer than ten participants, and articles lacking full text or endocrine data were excluded. Results: Subclinical hypothyroidism occurred in 18–42% of affected children, insulin resistance in over 65%, reduced testosterone and sex hormone-binding globulin in boys, and vitamin D deficiency in 55–70% of cases. These disturbances correlated with liver enzyme elevations and steatosis severity. Weight reduction of 7–10% improved insulin resistance, thyroid and sex hormone parameters, and vitamin D status. Preliminary findings support potential benefits of vitamin D supplementation and levothyroxine therapy, though large-scale trials remain limited. Conclusions: Metabolic dysfunction-associated fatty liver disease in children is a multisystem condition where hormonal dysfunction contributes to disease progression. Comprehensive endocrine evaluation should be part of standard care. Further research is needed, particularly in younger children, girls, and diverse populations.