Nonalcoholic steatohepatitis and nonalcoholic Fatty liver disease in young women with polycystic ovary syndrome.
BACKGROUND
Nonalcoholic fatty liver disease and polycystic ovary syndrome (PCOS) are both associated with insulin resistance. Thus, women with PCOS may have an increased prevalence of nonalcoholic fatty liver disease, including nonalcoholic steatohepatitis (NASH).


OBJECTIVE
The objective of the study was to determine the prevalence and characteristics of NASH and abnormal aminotransferase activity in women with PCOS.


METHODS
The study is a retrospective chart review.


METHODS
The setting is an academic endocrinology clinic.


METHODS
Patients were 200 women with PCOS, defined as irregular menses and hyperandrogenism.


METHODS
Biopsy-documented NASH and aminotransferase levels were the main outcome measures.


RESULTS
Fifteen percent (29 of 200) had aspartate aminotransferase and/or alanine aminotransferase more than 60 U/liter. Women with aminotransferase elevations had lower high-density lipoprotein (HDL) (41 vs. 50 mg/dl, P = 0.006), higher triglycerides (174 vs. 129 mg/dl, P = 0.024), and higher fasting insulin (21 vs. 12 microIU/ml, P = 0.036) compared with women with normal aminotransferases. Six women (mean age 29 yr) with persistent aminotransferase elevations underwent liver biopsy. All six had NASH with fibrosis. Compared with the 194 of 200 PCOS women who did not undergo biopsy, women with biopsy-documented NASH had lower HDL (median 34 vs. 50 mg/dl, P < 0.001), and higher triglycerides (245 vs. 132 mg/dl, P = 0.025), fasting insulin (26 vs. 13 microIU/ml, P = 0.038), aspartate aminotransferase (144 vs. 22 U/liter, P < 0.001), and alanine aminotransferase (143 vs. 28 U/liter, P < 0.001).


CONCLUSIONS
Abnormal aminotransferase activity is common in women with PCOS. Low HDL, high triglycerides, and high fasting insulin were associated with abnormal aminotransferase activity. Some women already had evidence of NASH with fibrosis. Further studies are needed to evaluate whether to screen PCOS women for liver disease at an earlier age than is currently recommended for the general population.
Department of Medicine, Division of Endocrinology, Duke University Medical Center, Box 3611, Durham, North Carolina 27710, USA. setji001@mc.duke.edu
Tracy L
TL
Setji
Nicole D
ND
Holland
Linda L
LL
Sanders
Kathy C
KC
Pereira
Anna Mae
AM
Diehl
Ann J
AJ
Brown
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology; D005260:Female; D006505:Hepatitis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008111:Liver Function Tests; D024821:Metabolic Syndrome / Q000378:metabolism; D008875:Middle Aged; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000473:pathology
D007328:Insulin; D008055:Lipids; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase