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This version published online on February 21, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-2774
A more recent version of this article appeared on May 1, 2006
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Submitted on December 20, 2005
Accepted on February 14, 2006

Nonalcoholic steatohepatitis and nonalcoholic fatty liver disease in young women with polycystic ovary syndrome

Tracy L. Setji MD*, Nicole D. Holland BS, Linda L. Sanders MPH, Kathy C. Pereira MSN, Anna Mae Diehl MD, and Ann J. Brown MD

Endocrinology Fellow, Department of Medicine, Division of Endocrinology, Duke University Medical Center, Box 3924, Durham, NC 27710, Phone: 919-684-4005, Fax: 919-681-7796, setji001@mc.duke.edu; Duke University Undergraduate; Department of Medicine, Duke University Medical Center; Department of Medicine, Division of Endocrinology, Duke University Medical Center; Department of Medicine, Division of Gastroenterology, Duke University Medical Center; Department of Medicine, Division of Endocrinology, Duke University Medical Center

* To whom correspondence should be addressed. E-mail: setji001{at}mc.duke.edu.

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

Objective: To determine the prevalence and characteristics of NASH and abnormal aminotransferase activity in women with PCOS.

Design: Retrospective chart review.

Setting: Academic endocrinology clinic.

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

Main Outcome Measures: biopsy-documented NASH, aminotransferase levels.

Results: Fifteen percent (29/200) had AST and/or ALT >60 U/L. Women with aminotransferase elevations had lower 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 uIU/ml, P = 0.036) compared with women with normal aminotransferases. Six (6/200) women (mean age 29 yr) with persistent aminotransferase elevations underwent liver biopsy. All six had NASH with fibrosis. Compared with the 194/200 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 uIU/ml, P = 0.038), AST (144 vs. 22 U/L, p=<0.001) and ALT (143 vs. 28 U/L, p=<0.001).

Conclusion: 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.
Key words: Polycystic ovary syndrome • nonalcoholic steatohepatitis • nonalcoholic fatty liver disease • abnormal aminotransferase • insulin resistance • fatty liver




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Re: Steatohepatitis and fatty liver in women with PCOS
Walter Futterweit, et al.
JCEM Online, 7 Jul 2006 [Full text]

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