S2873 Assessing for MASLD in Women With PCOS: A Single Center Observational Study

Introduction: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Polycystic Ovarian Syndrome (PCOS) are both associated with obesity, inflammation, and insulin resistance. Patients with PCOS have an incidence of MASLD of up to 40%. Guidelines for managing PCOS include screening for diabetes and hyperlipidemia, but do not include screening for MASLD. We evaluated the current state of assessment for MASLD in women with PCOS at a single academic center. Methods: A retrospective chart review of 150 patients was conducted. Female patients receiving care for PCOS at one of our center’s outpatient clinics (Internal Medicine, Family Medicine, Obstetrics and Gynecology (OBGYN), or Endocrinology) were included. Those lacking a formal PCOS diagnosis were excluded. Data collected includes demographics, timing and values of initial liver function tests (LFTs), abdominal imaging, and liver stiffness testing. A FIB-4 score was calculated for each patient when feasible. Results: Patients had an average age of 37 and average BMI of 36.5. 130/150 (87%) had LFTs checked during their care for PCOS. Average time from diagnosis or first appointment for PCOS to LFT draw was 5 years. 16% (24/150) of patients had abdominal ultrasound performed, 67% (16/24) of which revealed hepatic steatosis. Among the patients who had an ultrasound with hepatic steatosis, 69% (11/16) had normal LFTs. No patients had a documented FIB-4 score in the chart. Of the patients whose LFTs were checked, 8 had a FIB-4 greater than 1.3, yet only 4 of these underwent an abdominal ultrasound, and none had further liver stiffness testing. Only 2 patients from the cohort had elastography performed. Conclusion: Preliminary data indicates healthcare providers treating PCOS are conducting limited evaluations for MASLD, primarily collecting LFTs but often several years after a PCOS diagnosis without further follow-up. A majority of patients with steatosis on imaging had normal LFTs, raising the question of the optimal approach for evaluating MASLD in patients with PCOS. For patients with FIB-4 >1.3, none underwent further liver stiffness testing, raising concerns about undetected fibrosis. These results underscore the need for a standardized screening algorithm to facilitate early identification and management of MASLD in women with PCOS to prevent progression to liver fibrosis. This assessment was limited by manual chart reviews, and we aim to expand our study and ultimately develop a recommended screening algorithm.