MON-175 Exploring the Role of Androgen Excess in Non-Alcoholic Fatty Liver Disease Among Lean Women with PCOS: A Systematic Review

Abstract

Disclosure: C. Naranjo Llamas: None. M.J. Barroso Alverde: None. A. Aguilar Rico: None. A. Mizrahi Drijanski: None. V. Suarez Valezzi: None. I. Noemi Torres: None. L. Garcia-Colin Murillo: None. L. Padron Alcantara: None.

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder affecting reproductive-age women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Non-Alcoholic Fatty Liver Disease (NAFLD), a metabolic liver disorder, has been increasingly linked to PCOS, even in lean women. Hyperandrogenism is hypothesized to independently contribute to NAFLD through mechanisms involving oxidative stress, lipid dysregulation, and systemic inflammation. Despite its lower prevalence in lean PCOS women compared to obese phenotypes, NAFLD remains significantly more common in this population than in non-PCOS controls.This review aims to evaluate the association between androgen excess and the prevalence or severity of NAFLD in lean women with PCOS. It explores potential mechanisms linking hyperandrogenism to NAFLD, independent of obesity and insulin resistance. Following PRISMA guidelines, a systematic review was conducted using PubMed. Keywords and MESH terms included: "Polycystic Ovary Syndrome," "Lean," "Non-Obese," "Androgen Excess," "Hyperandrogenism," and "Non-Alcoholic Fatty Liver Disease." Observational studies, interventional studies, systematic reviews, meta-analyses, and case series published over the past 15 years were included. Data on population characteristics, androgen levels, NAFLD diagnostics, and outcomes were extracted and qualitatively synthesized due to study heterogeneity.Five studies meeting the inclusion criteria highlighted hyperandrogenism as a significant risk factor for NAFLD in lean PCOS women. One meta-analysis reported a 40% NAFLD incidence among this population. Elevated androgen levels, such as free androgen index and testosterone, were strongly associated with hepatic fat accumulation, independent of body mass index or insulin resistance. Advanced imaging modalities, including proton magnetic resonance spectroscopy ([1H]-MRS), confirmed increased liver fat content in hyperandrogenic PCOS women. Mechanistic insights revealed that oxidative stress, lipid dysregulation, and systemic inflammation mediated the impact of androgen excess on liver health.Hyperandrogenism is a significant independent risk factor for NAFLD in lean women with PCOS, emphasizing the need for tailored screening and management strategies. Although lean PCOS women exhibit a lower prevalence of NAFLD compared to obese counterparts, their risk surpasses that of non-PCOS controls. Future research should focus on elucidating the mechanisms linking hyperandrogenism to hepatic steatosis, developing targeted therapies, and addressing this underexplored population in clinical practice.

Presentation: Monday, July 14, 2025