EP44 - ECE_3714 - Adrenal incidentaloma and risk of metabolic dysfunction–associated fatty liver disease (MAFLD) and liver fibrosis assessed by non-invasive scores

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Abstract Background Adrenal incidentalomas (AI) are frequently associated with adverse metabolic profiles, even in the absence of overt hormonal hypersecretion. Mild autonomous cortisol secretion (SAC) may contribute to insulin resistance, dyslipidemia, and chronic low-grade inflammation, key drivers of MAFLD and liver fibrosis (LF). However, the prevalence of MAFLD and its relationship with AI characteristics remain poorly defined. Objective To assess the prevalence of MAFLD and LF using non-invasive scores (FIB-4 and APRI) in patients with AI and to evaluate their association with tumor characteristics after adjustment for metabolic risk factors. Methods Retrospective observational study including 76 patients with radiologically diagnosed AI followed at a specialized adrenal pathology clinic. Epidemiological and metabolic data were collected. AI were classified according to hormonal functionality (non-functioning vs SAC), maximal tumor diameter, and laterality (unilateral vs bilateral). MAFLD was defined according to standard criteria using liver imaging and metabolic factors. LF risk was estimated using FIB-4 and APRI scores and categorized as low vs intermediate/high. Group comparisons were performed using t-tests, chi-square tests, and Pearson correlations. Multivariable binary logistic regression was used to identify independent predictors of intermediate/high fibrosis risk. Results Mean age was 63 ± 10.5 years, 54% were women, and 49% had obesity. Non-functioning adenomas were present in 44.7% and SAC in 55.3%. Low fibrosis risk was observed in 92.1% by APRI and 56.6% by FIB-4, while 43.4% had intermediate/high risk by FIB-4. MAFLD prevalence was 27.6%. In multivariable analysis, age was inversely associated with low fibrosis risk (OR 0.85, 95% CI 0.77–0.93; P < .001). Metabolic factors (BMI, type 2 diabetes, dyslipidemia, and hypertension) were independently associated with intermediate/high fibrosis risk (adjusted OR 1.3–2.5, all P < .05). Tumor functionality, size, and laterality were not independently associated with fibrosis scores. Conclusions More than one-quarter of patients with AI have MAFLD, and a substantial proportion show intermediate/high risk of liver fibrosis. Fibrosis risk is mainly driven by metabolic comorbidities rather than adrenal tumor characteristics, highlighting the need for systematic metabolic and hepatic assessment in all patients with AI.

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