Endocrine Abstracts

Background: Nonalcoholic fatty liver disease (NAFLD) has been associated with insulin resistance. As polycystic ovary syndrome (PCOS) is also associated with insulin resistance, the presence of NAFLD has been investigated in patients with the syndrome and there are data showing an increased prevalence of abnormal aminotransferance activity and/or ultrasonographic evidence of hepatic steatosis.

Objective: In the present prospective study women with PCOS were evaluated with abdominal ultrasonography and biochemical testing in order to assess the presence of NAFLD and to identify factors associated with NAFLD in PCOS.

Patients-methods: Thirty-seven patients (Androgen Excess Society criteria), aged 16–48 years (25.8±7.0), with a BMI 16.8–45.3 kg/m² (29.4±7.6) (17 obese, 8 overweight, 12 lean) were studied in the early follicular phase. None of the women had a history of liver disease or reported significant alcohol consumption. None was receiving any medication at the time of the study. They had a clinical examination, a biochemical evaluation (fasting glucose and insulin, lipid profile, liver function tests, FSH, LH, Prl, E₂, testosterone, Δ₄, DHEA-S, SHBG) and underwent a liver and a pelvic ultrasound. Ultrasonography was performed by the same radiologist. Insulin resistance was assessed by homeostasis model assessment (HOMA-IR).

Results: Ultrasonography detected fatty infiltration of the liver in 15/37 patients (41.7%). Patients with abnormal liver ultrasonography were older (P<0.05), had a higher BMI (P<0.01), waist circumference (P<0.001), fasting insulin (P<0.005), HOMA-IR (P<0.005), serum triglycerides (P<0.05), free androgen index (P<0.05) and a lower SHBG (P<0.001) and HDL-cholesterol (P<0.005) versus patients with normal liver ultrasonography. No differences were found concerning levels of aminotransferance activity and the presence of polycystic ovarian morphology on ultrasound. Abnormal aminotransferance activity (SGPT>40 IU/l) was detected in 8/37 patients (21.6%), 5 of them having abnormal liver ultrasonography. No differences were found between patients with abnormal and those with normal aminotransferance activity.

Conclusion: PCOS patients are at increased risk for developing NAFLD. Despite hepatic steatosis on ultrasound, liver biochemical tests may be normal, so liver ultrasonography is the best option for the detection of NAFLD. Metabolic abnormalities of the syndrome seem to be related with the presence of NAFLD.