Nonalcoholic fatty liver disease in subjects with adrenal incidentaloma

Eur J Clin Invest 2012; 42 (11): 11651172 Abstract 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 (Delta L-Delta S) < -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 Delta L-Delta S and, hence, degree of hepatic steatosis. Conclusions There was no significant difference in the presence of NAFLD between AI patients and controls. Delta L-Delta S, an inverse index of NAFLD, was independently associated with abdominal obesity and increased triglycerides.