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Article: Tracy L. Setji, Nicole D. Holland, Linda L. Sanders, Kathy C. Pereira, Anna Mae Diehl, and Ann J. Brown Nonalcoholic steatohepatitis and nonalcoholic fatty liver disease in young women with polycystic ovary syndrome J Clin Endocrinol Metab 2006; 0: jc.2005-2774v1 [Abstract]

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Re: Steatohepatitis and fatty liver in women with PCOS

Walter Futterweit, Thomas Schiano,Hsu-Chong Yeh,Maya Gambarin-Gelwan   (7 July 2006)

Re: Steatohepatitis and fatty liver in women with PCOS 7 July 2006
Walter Futterweit, MD,FACP Mount Sinai School Medicine, Thomas Schiano,Hsu-Chong Yeh,Maya Gambarin-Gelwan Send letter to journal: Re: Re: Steatohepatitis and fatty liver in women with PCOS wfutt{at}ix.netcom.com Walter Futterweit, et al.	We read with interest the article of Setji et al (1) and agree with their data demonstrating that 15% of women with polycystic ovary syndrome (PCOS) have abnormal liver function tests. Similar findings of 15% abnormal liver chemistries were found in our study of 88 consecutive PCOS women who demonstrated graded severity on ultrasonography of the liver, and a non-alcoholic fatty liver disease (NAFLD) incidence of 55% (2). Steatohepatitis and fibrosis on liver biopsy were described in Setji et al’s study of 6 PCOS women with abnormal liver function tests; only 13 women in Setji’s report underwent ultrasonography and no details of the grade of steatosis was reported. Since normal liver function test results do not exclude NAFLD (3), we suggest that ultrasound is a useful tool in the assessment of NAFLD and may possibly be another clinical guide to the use of liver biopsies in patients with severe steatosis. The overall accuracy of an ultrasound in detecting NAFLD has been noted to be 85%, with 100% sensitivity and 56% specificity (4). Using both liver function tests and ultrasound may diagnose NASH earlier, and prompt a proactive approach that could reduce its impact on the patient’s health, with lifestyle modification and/or insulin-sensitizing agents. Further studies are needed to provide definitive answers on whom to employ liver biopsies in women with PCOS and NAFLD. References 1. Setji TL, Holland ND, Sanders LL, Pereira KC, Diehl AM, Brown AJ. 2006 Nonalcoholic steatohepatitis and nonalcoholic fatty liver disease in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 91:1741-1747 2. Kinkhabwala S, Schiano TD, Futterweit W, Gambarin-Gelwan M, Bodian C, Yeh HC. 2005 Prevalence of non-alcoholic fatty liver disease in polycystic ovary syndrome. Program of the 87th Annual Meeting of the Endocrine Society, San Diego, CA, 2005, p 445 3. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM, Hobbs HH. 2004 Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387-1395 4. Scatarige JC, Scott WW, Donovan PJ, Siegelman SS, Sanders RC. 1984 Fatty infiltration of the liver: ultrasonographic and computed tomographic correlation. J Ultrasound Med 3:9-14