Nonalcoholic fatty liver disease in subjects with adrenal incidentaloma

• Published in: European journal of clinical investigation Vol. 42; no. 11; pp. 1165 - 1172
• Main Authors: Papanastasiou, Labrini, Pappa, Theodora, Samara, Christianna, Apostolopoulou, Glyceria, Tsiavos, Vaios, Markou, Athina, Alexandraki, Krystallenia, Piaditis, George, Chrousos, George, Kaltsas, Gregory
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2012; Wiley-Blackwell
• Subjects: Adrenal Gland Neoplasms - etiology; Adrenal Gland Neoplasms - metabolism; Adrenal incidentaloma; Age; Aldosterone; Aldosterone - analysis; Anthropometry; Biological and medical sciences; Body Mass Index; Case-Control Studies; Computed tomography; Fatty liver; Fatty Liver - diagnosis; Fatty Liver - etiology; Fatty Liver - metabolism; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Glucose tolerance; Humans; Hydrocortisone; Hydrocortisone - analysis; Insulin; insulin resistance; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Metabolic diseases; Metabolic disorders; metabolic syndrome; Metabolic Syndrome - complications; Metabolic Syndrome - metabolism; Middle Aged; Miscellaneous; Multiple regression analysis; Non-alcoholic Fatty Liver Disease; nonalcoholic fatty liver disease; Obesity; Other diseases. Semiology; Other metabolic disorders; Pheochromocytoma; Prevalence; Regression Analysis; Risk factors; Secretion; Spleen; steatosis; Tomography, X-Ray Computed; Triglycerides; Waist-Hip Ratio; Endocrinopathy; Human; Pancreatic hormone; Adrenal gland neoplasm; Metabolic diseases; Cardiovascular disease; Hepatic disease; Metabolic syndrome; Insulin; Adrenal incidentaloma; Medicine; Target tissue resistance; nonalcoholic fatty liver disease; Non alcoholic steatohepatitis; Adrenal gland diseases; Digestive diseases; Insulin resistance
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/j.1365-2362.2012.02707.x

Eur J Clin Invest 2012; 42 (11): 1165–1172 Background  Adrenal incidentalomas (AI) are associated with several parameters of the metabolic syndrome (MS). Although nonalcoholic fatty liver disease (NAFLD) is considered a cardiometabolic risk factor, no data exist on its prevalence and clinical relevance in AI. The aim was to investigate the presence of MS and NAFLD in AI subjects. Patients and Methods  Fifty‐six AI subjects and 30 age‐, sex‐ and body mass index (BMI)‐matched controls were evaluated. All subjects underwent abdominal computerized tomography scan and hepatic and spleen attenuation measurements. The presence of NAFLD was defined as a mean hepatic minus mean spleen attenuation difference (ΔL−ΔS) < −10HU. Anthropometric variables [BMI and waist‐to‐hip ratio (W/H)] were recorded, and biochemical parameters were measured. An oral glucose tolerance test was performed, and several insulin resistance (IR) indices were determined. All subjects underwent testing to reveal autonomous cortisol and/or aldosterone (ALD) secretion, while the diagnosis of pheochromocytoma was ruled out. Results  Adrenal incidentaloma subjects’ mean age (± standard deviation) was 59·64 (± 8·68) years, BMI 29·84 (± 5·85) kg/m2 and W/H 0·90 (± 0·07). Twelve subjects with AI had subtle autonomous cortisol, five autonomous ALD and three combined cortisol and ALD secretion. AI subjects exhibited higher IR indices than controls. NAFLD was present in three AI subjects and two controls. In the multiple regression analysis, W/H and triglycerides were independently associated with a low ΔL−ΔS and, hence, degree of hepatic steatosis. Conclusions  There was no significant difference in the presence of NAFLD between AI patients and controls. ΔL−ΔS, an inverse index of NAFLD, was independently associated with abdominal obesity and increased triglycerides.