PCOS who also have higher ALT levels should avoid alcohol and acetaminophen

PCOS Linked to Higher Risk of Liver Disease

by John C. Martin
Article Date: 03-08-05

Women with a disease of the ovaries known as polycystic ovary syndrome (PCOS) face a higher risk of developing liver disease, claim doctors in Southern California.1 This finding is important for doctors who may not be aware that women with PCOS face this higher risk, and thus treat them with medications that could be toxic to the liver, say the study’s investigators.

PCOS is a disorder caused by a hormone imbalance, which may be linked with the way the body processes insulin. Insulin is a hormone produced by the body that promotes the use of blood sugar. When there are problems with the way insulin is used, the ovaries can produce an abnormal abundance of male hormones, which is characteristic of PCOS.

Among the signs of PCOS is the growth of abnormal cysts on the ovaries. This is accompanied by irregular menstrual cycles. Women diagnosed with PCOS can often become infertile.

Symptoms of the disease include hirsutism (abnormal growth of hair), thinning hair, acne, weight gain, and depression and anxiety.2

The Liver Disease Link Examined
In their study published in the journal Fertility and Sterility, physicians at the University of California at San Diego theorized that PCOS is connected with a higher risk of developing non-alcoholic fatty liver disease, or NAFLD. This is an umbrella term used to describe a range of liver diseases, from benign to potentially fatal, characterized by the accumulation of fat in the liver.3 This increase in fatty liver risk can be caused by different things, such as diabetes, weight gain, poor diet or associated illnesses like tuberculosis. The worst kind of fatty liver disease is known as non-alcoholic steatohepatitis (NASH), which is diagnosed when accumulated fat causes liver inflammation, resulting in damage. NASH is not associated with hepatitis.4

“We hypothesized that women with PCOS would demonstrate a high incidence of NAFLD because of the link to insulin resistance,” explained Walter Schwimmer, MD, of Kaiser Permanente Medical Center in Bellflower, California, one of the study’s investigators. Insulin resistance is a shared characteristic of both PCOS and NAFLD.

“The data in the study, in fact, demonstrate that elevated ALT is more common in women with PCOS than in the general population of women of a similar age, race and body weight,” Schwimmer said.

ALT stands for alanine aminotransferase (AL-uh-neen uh-meen-oh-TRANZ-fer-aze), an enzyme released by the liver into the bloodstream when the liver is damaged.5 As such, doctors look for levels of ALT as a sign of liver disease.

Patient Data Collected
For their study, the researchers led by Jeffrey Schwimmer, MD, an assistant clinical professor of Pediatrics, reviewed the records of 70 women who had been evaluated for infertility at an area hospital. Information on height, weight, blood pressure, hirsutism, liver enzyme levels, fasting glucose, fasting insulin, and cholesterol was gathered.

Schwimmer and his team found that nearly a third of the women diagnosed as having PCOS had higher-than-normal levels of ALT, indicating the presence of liver disease. Additionally, levels of another liver enzyme, aspartate aminotransferase (as-PAR-tate uh-meen-oh-TRANZ-fer-aze), or AST, were increased in 12 percent of the patients studied. “All seven subjects with an elevated AST also had an elevated ALT,” the researchers noted.

Women with higher ALT levels also significantly weighed more, had a higher waist circumference, increased triglyceride levels, and higher cholesterol, they found. “There was a significant association between the presence of hirsutism and the finding of an abnormal ALT in women with PCOS,” wrote Schwimmer’s team. The link between fatty liver disease and hirsutism was “very unexpected”, Walter Schwimmer said.

“We determined that insulin resistance explains the high rate of elevated ALT in women with PCOS, and that these women with PCOS are at increased risk for NAFLD,” Walter Schwimmer said.

Study Caveat
But the investigators also cautioned that since liver biopsies weren’t performed in the study, it was not possible to determine the true prevalence of NAFLD in the group of women.

In conclusion, the investigators recommend that women diagnosed with PCOS who also have higher ALT levels avoid alcohol and acetaminophen, both of which can be toxic to a diseased liver.

1. Schwimmer JB, Khorram O, Chiu V, Schwimmer WB. Abnormal aminotransferase activity in women with polycystic ovary syndrome. Fertil Steril 2005 Feb;83(2):494-7.
2. The Hormone Foundation. PCOS: Symptoms. Available at: http://www.hormone.org/learn/pcos_2.html. Accessed March 8, 2005.
3. Hepatitis Neighborhood. NAFLD: Nonalcoholic Fatty Liver Disease. Available at: http://www.hepatitisneighborhood.com/content/
understanding_hepatitis/other_forms_of_hepatitis_1508.aspx. Accessed March 1, 2005.
4. American Liver Foundation. What is NAFLD/NASH? Available at: http://www.liverfoundation.org/cgi-bin/dbs/articles.cgi?db=articles&uid=default&ID=1027&view_records=1. Accessed March 1, 2005.
5. Summaries for Patients. New definitions for healthy ranges of alanine aminotransferase, a blood test of liver function. Ann Intern Med 2002 Jul 2;137(1):1-37.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television’s The Health Network, and articles for the New York Post and other consumer and trade publications.