Endocrine Abstracts

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women of reproductive age, often characterized by obesity and insulin-resistance. NAFLD (Non-Alcoholic Fatty Liver Disease) is a metabolic disorder characterized by the accumulation of fat in the liver, in absence of alcohol consumption and other possible causes of hepatosteatosis. The association between hepatosteatosis and at least one cardio-metabolic risk factor is defined as MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease). A high prevalence of NAFLD in PCOS has been observed in several studies. The purpose of this study was to evaluate the prevalence of NAFLD, MASLD and hepatic fibrosis in patients affected by PCOS. In this prospective study 38 consecutive PCOS patients (mean age 23 years, IQR 6) were recruited at the Department of Endocrinology of Pisa. The diagnosis of PCOS was made following the International PCOS Network Guidelines. The diagnosis of NAFLD was based on laboratory assessment of liver function and liver imaging studies, by the use of ultrasound and transient elastography (TE) or Fibroscan, that estimates hepatosteatosis and fibrosis by measuring the Controlled Attenuation Parameter (CAP) and the Liver Stiffness Measure (LSM). Patients were divided in different groups according to their BMI (19% normal weight, 18 overweight and 63% obese) and to the presence of insulin-resistance (36.8% of the women). 31 out of 38 patients (81.6%) had hepatosteatosis at ultrasound; the majority of women (42.1%) exhibiting mild steatosis. The CAP revealed the presence of hepatosteatosis in the 47.2% of patients. The measurement of LSM showed that 72.3% of women had values >5 kPA, indicative of reduced liver elasticity. The 90.3% of the patients were diagnosed by MASLD, primarily due to the overweight. There weren’t significant differences in liver stiffness values between insulin-resistant (IR) and non-insulin-resistant (NIR) patients. The BMI was higher in patients with hepatosteatosis and progressively increases according to the severity of the steatosis. A correlation between hyperandrogenism and hepatosteatosis in PCOS we observed: the values of FAI (Free Androgen Index) were significantly higher in patients with steatosis, especially if moderate/severe, and SHBG (Sex Hormone Binding Globulin) levels were significantly lower. The association between hepatosteatosis and SHBG remained significant independently of insulin-resistance. Furthermore, the levels of 17-OH-progesterone were significantly lower in patients with more sever liver damage. In conclusion, patients with PCOS show an increased prevalence of NAFLD, primarily due to the presence of obesity, insulin-resistance and hyperandrogenism.