Prevalence of metabolic-associated fatty liver disease in patients with primary aldosteronism

Objective: to assess the prevalence of metabolic associated fatty liver disease (MAFLD) in patients with primary aldosteronism (PA) compared to other benign adrenal nodules, and evaluate the impact of hormonal excess in inducing MAFLD.
Design: a monocentric retrospective study at Padova Hospital.
Methods: a cohort of 175 patients was analyzed: 41 with PA (20 surgically treated, PAsurgery , and 21 treated with mineralcorticoid receptor antagonist, PAMRA), 50 nonfunctioning adrenal incidentalomas (NF-AI), 48 adenomas with mild autonomous cortisol secretion (MACS), 10 adrenal Cushing Syndrome (CS) and 26 healthy controls. We proposed a new definition of MAFLDendocrine, including hormonal excess as a diagnostic criteria, to assess the impact of endocrine excess in the pathogenetic process.
Results: MAFLD prevalence was higher in PA compared to MACS (49% vs 25%, p<0.05) and NF-AI (49% vs 14%, p<0.001), but similar to CS (49% vs 45%, p=0.61). PAsurgery patients had higher prevalence of both MAFLDclassical and MAFLDendocrine compared to PAMRA group (70% vs 29% MAFLDclassical and 75% vs 28% MAFLDendocrine). Within patients with hormone excess, 5/63 (8%) patients negative for MAFLDclassical fulfilled diagnostic criteria for MAFLDendocrine. L/S ratio differed between PA and NF-AI (mean L/S ratio 1.10 vs 1.25, p < 0.001), MACS (mean L/S ratio 1.10 vs 1.21, p 0.007), and controls (mean L/S ratio 1.10 vs 1.35, p < 0.001), but was comparable with adrenal CS (mean L/S 1.10 vs =1.15, p = 0.147).
Conclusions: we reported a considerable prevalence of MAFLD in PA, higher in PAsurgey compared to PAMRA, and similar to adrenal CS. MAFLDendocrine identified patients at high risk of MAFLD who do not fulfill classical diagnostic criteria.