The Link Between Acromegaly, Liver Morphology, and MASLD: A Large Cohort Analysis
Polat Ercan, Busra Firlatan Yazgan, Suleyman Nahit Sendur, Selcuk Dagdelen, Tomris ErbasAbstract
Objective
To evaluate liver morphology and clinical determinants in acromegaly.
Design
Retrospective single-center cohort study.
Methods
We analyzed 394 acromegaly patients followed at a single tertiary center over four decades for hepatic morphology and metabolic dysfunction-associated steatotic liver disease (MASLD). Patients were compared by hepatic cyst and MASLD status; multivariable logistic regression identified independent predictors, using outcome-specific primary hormonal exposures—the peri-imaging IGF1×ULN for MASLD and time-weighted-average IGF1×ULN (TWAvg) for hepatic cysts. Standardized prevalence ratios (SPR) against age- and sex-stratified references were also examined.
Results
Of 282 imaged patients, MASLD, hepatic cyst, hemangioma, and cholelithiasis prevalence was 31.0%, 15.6%, 4.3%, and 36.8%. Cyst prevalence matched population estimates, whereas imaging-detected MASLD was significantly lower than expected (SPR 0.56–0.78). Hepatic cyst was independently associated with renal cyst (OR 2.769) and inversely with MASLD (0.231), with older age borderline significant. MASLD was inversely associated with the peri-imaging IGF1×ULN (OR 0.74 per doubling), hepatic cyst (0.109), and longitudinal exposure (log2 TWAvg IGF1×ULN 0.61), and positively with cholelithiasis (3.158).
Conclusions
Hepatic cyst prevalence matched population estimates, whereas imaging-detected MASLD was significantly lower. Cysts associated with older age, renal cysts, and absence of MASLD; MASLD associated inversely with the peri-imaging and longitudinal IGF1 exposure and positively with cholelithiasis. The inverse cyst–MASLD relationship is hypothesis-generating: MASLD tracked GH/IGF1 activity whereas cysts did not, suggesting distinct hepatic phenotypes of a shared, as-yet-unmeasured determinant rather than opposite readouts of one hormonal signal.