Hepatic steatosis in patients with acromegaly

Abstract

Objective Comorbid NAFLD is increasingly being diagnosed in patients with diabetes and nondiabetic endocrinopathies. The aim of this study was to assess hepatic steatosis noninvasively by transient elastography in patients with acromegaly. Design A cross‐sectional study including 22 patients with acromegaly. Methods Hepatic steatosis was quantified using controlled attenuation parameter (CAP) during elastography. Anthropometric measurements were obtained, serum liver function tests and lipid and hormone profiles were measured, and prosteatogenic gene variants were genotyped using standard assays. Results In total, 41% of patients were women (mean age 60 ± 14.7 years, mean BMI 31.2 ± 4.6 kg/m2). Hepatic steatosis, as defined by CAP > 248 dB/m, was present in 66% of patients. Five (45%) of the patients with hepatic steatosis also had fibrosis, and one presented with cirrhosis. Nine patients were carriers of the PNPLA3 p.I148M prosteatogenic [M] risk allele, eight of whom were heterozygotes. CAP values were significantly (P = .045) higher in these patients and corresponded to advanced steatosis, as compared to patients with the wild‐type genotype, who demonstrated CAP values consistent with mild steatosis (311 ± 33 dB/m. vs 254 ± 62 dB/m). CAP values did not differ significantly in carriers of distinct TM6SF2 and MBOAT7 genotypes; however, carriers of the risk alleles displayed higher CAP as compared to wild‐type patients. Conclusions This study shows that in patients with acromegaly, carriers of the PNPLA3 susceptibility allele are at risk of developing hepatic steatosis, as assessed by CAP. Comorbid NAFLD might compound prognosis in such patients; thus, further research into the pathomechanisms and treatment of NAFLD in acromegaly is warranted.

Nonalcoholic Fatty Liver Disease, Liver Fibrosis, and Utility of Noninvasive Scores in Patients With Acromegaly

“…Although NAFLD is common in the community, the true prevalence of NAFLD in patients with acromegaly is unknown. In a German study in which 80% of the subjects had well-controlled acromegaly, ultrasonography (US) revealed NAFLD in 66% of the participants ( 35 ). Ciresi et al found that 61% of patients with active acromegaly at diagnosis had NAFLD determined by the US.…”

Acromegaly: Clinical Care in Central and Eastern Europe, Israel, and Kazakhstan

“…A study from Croatia has shown lower calcaneus quantitative ultrasound parameters and increased bone turnover in male patients with active acromegaly ( 28 ). Hepatic steatosis is another comorbidity that has recently been reported at relatively high rates in patients with acromegaly, though the studies included small numbers of patients ( 29 , 30 ). Genetic markers that may help identify patients with increased risk from these comorbidities have been studied ( 30 , 31 ).…”

“…Hepatic steatosis is another comorbidity that has recently been reported at relatively high rates in patients with acromegaly, though the studies included small numbers of patients ( 29 , 30 ). Genetic markers that may help identify patients with increased risk from these comorbidities have been studied ( 30 , 31 ).…”

Pathophysiology of NASH in endocrine diseases

“…Few studies to date have shown an association between acromegaly and NAFLD prevalence, and in particular the hepatic steatosis index (HSI). Interestingly, a reduction of GH and IGF-1 levels after treatment induction in acromegaly has been associated with a reduction of the HSI ( 126 , 127 ). However, due to the relatively low prevalence of acromegaly, there is still limited data regarding its association with NAFLD and the impact of control of the disease with conventional treatments such as octreotide long-acting release on NAFLD progression or regression.…”