Non-Invasive Assessment of Metabolic Dysfunction-Associated Steatotic Liver Disease and Cardiovascular Risk in Acromegaly Indicates Persistence of Cardiac Risks Despite Biochemical Disease Control.

: Acromegaly is associated with multiple metabolic comorbidities, but the relationship between disease activity and metabolic dysfunction-associated steatotic liver disease (MASLD) or cardiovascular risk remains unclear. This study aimed to assess the prevalence and severity of MASLD and liver fibrosis in patients with acromegaly relative to healthy controls and explore whether disease activity influences these parameters. We also evaluated cardiovascular risk indicators in acromegaly patients. : A retrospective case-control study was conducted between 2000 and 2022, involving 58 acromegaly patients and 58 healthy controls. Patients were classified as active or in biochemical remission. MASLD was assessed using the fibrosis-4 (FIB-4) index, MASLD fibrosis score, body mass index, diabetes (BARD) score, the aspartate aminotransferase-to-platelet index (APRI), and the aspartate aminotransferase-to-alanine aminotransferase ratio. Cardiovascular evaluation included pulse wave velocity (PWV) and carotid intima-media thickness (CIMT). : The median age of the acromegaly group was 47.5 (39-57) years, compared to 42 (40-48) years in the control group ( = 0.041). APRI ( < 0.001), FIB-4 ( < 0.001), MASLD fibrosis score ( < 0.001), and BARD score ( < 0.001) were significantly higher in the acromegaly group. The prevalence of hepatic steatosis was also higher in the acromegaly group ( < 0.001). Diastolic blood pressure ( = 0.015) and PWV ( = 0.012) were significantly higher in the acromegaly group. : Acromegaly patients have an increased risk of MASLD and fibrosis, but this risk is unassociated with disease activity. Similarly, cardiovascular risk parameters remain elevated regardless of disease activity. These findings suggest that the systemic effects of acromegaly may persist despite biochemical control.