NONALCOHOLIC FATTY LIVER DISEASE IN TWO SUBTYPES OF PRIMARY ALDOSTERONISM

Abstract

Objective: Hyperaldosteronism have been reported to be associated with higher prevalence of nonalcoholic fatty liver disease (NAFLD). To clarify prevalence of NAFLD in two subtypes of primary aldosteronism (PA), we compared hepatic fat content evaluated by computed tomography (CT). Design and method: This retrospective observational study comprised 95 patients diagnosed with PA. We divided participants into two subtypes, aldosterone producing adenoma (APA) (n = 36) and idiopathic hyperaldosteronism (IHA) (n = 59). We evaluated hepatic fat content by the ratio of liver to spleen (L/S) Hounsfield units in unenhanced CT. We compared L/S ratio, visceral fat percentage (VF%), visceral fat area (VFA), hepatic steatosis index (HSI), fatty liver index (FLI), NAFLD fibrosis score, fibrosis-4 index (FIB4 index), and homeostasis model assessment insulin resistance (HOMA-R) between the two subtypes. Results: Age and sex distribution were not different between the two subtypes. Plasma aldosterone concentration (PAC) was significantly higher in patients with APA than patients with IHA (p < 0.01). VF% and VFA were not different between the two subtypes (p = 0.06, p = 0.74). L/S ratio was not different between the two subtypes (APA vs IHA; 1.1 ± 0.2 vs 1.2 ± 0.2, p = 0.40). HSI, FLI, NAFLD fibrosis score, and FIB4 index were not different between the two subtypes (p = 0.32, p = 0.67, p = 0.87, p = 0.95, respectively). HOMA-R was significantly higher in patients with IHA than patients with APA (p = 0.04). L/S ratio was neither correlated with PAC nor HOMA-R in each subtype. In both subtypes, L/S ratio was negatively correlated with VF% (APA: r = −0.55, p < 0.01, IHA: r = −0.58, p < 0.01), with VFA (APA: r = −0.49, p < 0.01, IHA: r = −0.54, p < 0.01). Conclusions: L/S ratio was not different between two subtypes of PA. Not insulin resistance or PAC but the amount of visceral fat was associated with L/S ratio in both subtypes. Those data suggested that prevalence of NAFLD was not different between two subtypes of PA, and it was affected by the amount of visceral fat.