Polycystic ovary syndrome patients with metabolic dysfunction-associated steatotic liver disease - comparison of the diagnostic methods

Abstract

Polycystic ovary syndrome (PCOS) is the most prevalent endocrinopathy affecting women of reproductive age. Except for the typical symptoms of this syndrome, metabolic disorders are relatively common. Metabolic dysfunction-associated steatotic liver disease (MASLD) diagnosis criteria include hepatic steatosis, excessive fat in the liver, and evidence of steatosis. Women with PCOS are more likely to have this kind of liver disease; thus, the diagnosis is essential. Early treatment is crucial in enhancing liver parameters, affecting the disease's overall course. Liver biopsy is the gold standard of MASLD diagnosis, but non-invasive screening methods are preferred due to possible health complications. Insulin resistance (IR), chronic inflammation, and hyperandrogenemia contribute to MASLD development in PCOS patients. Dysregulation of insulin signaling in the ovaries of PCOS women causes an increase in androgen production. Hyperandrogenism has been taken as the cofactor and independent indicator contributing to the mentioned disease. Excess of androgens in PCOS-affected women may be a guideline for running some MASLD tests to detect ongoing liver steatosis early. Calculators like FIB-4 (fibrosis index based on four factors), BAAT [body mass index (BMI), age, alanine transferase (ALT), triglycerides], and FLI (fatty liver index) are used to detect liver fibrosis or steatosis, making them the right tools for screening among PCOS patients if we aim to prevent further consequences of MASLD. The ultrasound evaluation of MASLD and liver fibrosis is an adequate tool due to its non-invasiveness, low cost, and high availability. Transient elastography makes it possible to find liver steatosis in PCOS patients with high sensitivity. Liver fibrosis interconnects frailly with PCOS; therefore, using FibroScan could be helpful as a screening tool, especially in young patients. If the aim is to rule out significant fibrosis, methods regarding fibrosis (FibroScan, FIB-4, BAAT) are preferable. Unfortunately, these methods are unsuitable for distinguishing between absent and initial fibrosis, and their usefulness is limited regarding fibrosis prevention. Methods regarding steatosis (emphasizing TE, FLI as a second-choice method) can detect liver steatosis, making them the right tool for screening among adult and teenage PCOS patients if the aim is to prevent further consequences of MASLD.

Keywords: BAAT; FIB-4; MASLD; PCOS; elastography.