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Metabolic Hyperferritinaemia — RACP Adult Medicine MCQ

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ModerateGastroenterologyMetabolic HyperferritinaemiaRACP Adult Medicine

A 50-year-old obese man (BMI 38) with type 2 diabetes and metabolic syndrome has a ferritin of 550 μg/L. TSAT is 28% (normal). HFE genotyping is normal (no C282Y or H63D). ALT is 75 U/L. CRP is 8 mg/L. He drinks 20 g alcohol/week. Liver USS shows steatosis. What is the most likely cause of raised ferritin?

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Correct answer: C — Metabolic syndrome-associated hyperferritinaemia

Mildly elevated ferritin with normal TSAT (ruling out true iron overload), negative HFE, metabolic syndrome features (obesity, T2DM), and hepatic steatosis is metabolic hyperferritinaemia (formerly NAFLD-associated hyperferritinaemia). This is the MOST COMMON cause of elevated ferritin in clinical practice. Ferritin is an acute phase reactant elevated in inflammation, metabolic syndrome, and liver disease. The normal TSAT is the key differentiator from haemochromatosis.

Reference: GESA – 2024; EASL 2024 MASLD