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Dysmetabolic hyperferritinemia

What's new

Added 2023 MHF-CG guidelines for the diagnosis and management of dysmetabolic hyperferritinemia.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of dysmetabolic hyperferritinemia are prepared by our editorial team based on guidelines from the Metabolic Hyperferritinemia Consensus Group (MHF-CG 2023) and the American Association for the Study of Liver Diseases (AASLD 2018). ...
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Screening and diagnosis

Diagnostic criteria
As per MHF-CG 2023 guidelines:
Consider defining the condition of hyperferritinemia related to metabolic dysfunction as metabolic hyperferritinemia. Consider grading the severity of metabolic hyperferritinemia according to serum levels of ferritin thresholds (grades 1-3).
C
Consider defining dysmetabolic iron overload syndrome as increased hepatic iron stores in patients with metabolic hyperferritinemia.
C
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Classification and risk stratification

Risk factors
As per MHF-CG 2023 guidelines:
Recognize that insulin resistance and features of metabolic dysfunction are associated with specific alterations of iron metabolism regulation, which are epidemiologically linked with organ damage and clinical outcomes.
B
Recognize that the pathophysiology of this alteration of iron metabolism regulation seems to be triggered by lipotoxicity in the presence of permissive environmental and genetic determinants.
B

Diagnostic investigations

Serum ferritin levels
As per MHF-CG 2023 guidelines:
Consider measuring serum ferritin levels for noninvasive diagnosis and assessment of iron metabolism alteration, namely thr metabolic hyperferritinemia, associated with glucose and lipid metabolism dysregulation and with hepatic lipid accumulation.
B
Consider measuring serum ferritin levels after at least 3 months of lifestyle changes, if possible.
C

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  • MRI

Diagnostic procedures

Liver biopsy: as per MHF-CG 2023 guidelines, do not perform a liver biopsy for the diagnosis of metabolic hyperferritinemia or dysmetabolic iron overload syndrome unless otherwise indicated for the management of an associated liver disease or for specific research purposes.
D

Medical management

Management of cardiovascular risk factors: as per MHF-CG 2023 guidelines, focus the clinical management on lifestyle factors associated with increased risk of cardiometabolic risk factors (such as caloric intake and dietary patterns, alcohol intake, fructose and salt intake, and sedentary lifestyle) and the pharmacological control of cardiovascular risk factors.
B

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  • Iron depletion therapy

Therapeutic procedures

Blood donation: as per MHF-CG 2023 guidelines, recognize that blood donation is not contraindicated in patients with metabolic hyperferritinemia with controlled cardiovascular risk factors, without organ damage or other contraindications to phlebotomy.
B