Primary aldosteronism is the most common secondary cause of hypertension, affecting 10% of hypertensive patients. Aldosterone excess in the setting of primary aldosteronism increases the risk of cardiovascular complications and glucometabolic dysregulation, including metabolic dysfunction-associated steatotic liver disease (MASLD).

Tizianel et al. assessed the prevalence of MASLD in patients with primary aldosteronism (without cortisol co-secretion) compared with hypertensive patients with non-functioning adrenal incidentalomas (NF-AI), mild autonomous cortisol secretion (MACS) and adrenal Cushing’s syndrome. Hepatic steatosis was assessed by liver/spleen ratio from unenhanced baseline abdominal computed tomography imaging. 

In their series, hepatic steatosis was significantly higher in patients with primary aldosteronism at diagnosis, compared with those with NF-AI or MACS, but similar to those with adrenal Cushing’s syndrome. Medical and surgical treatment in patients with primary aldosteronism significantly reduced hepatic steatosis. The prevalence of MASLD was significantly higher in primary aldosteronism (49%), compared with MACS (25%) or NF-AI (14%), but comparable with adrenal Cushing’s syndrome (45%).

Based on their findings, the authors reveal a heightened prevalence of MASLD in patients with primary aldosteronism compared with NF-AI and MACS, as well as improvements in hepatic steatosis after treatment.

Read the full article in Clinical Endocrinology https://doi.org/10.1111/cen.15231