Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women during the
reproductive period. True PCOS phenotype is prone to develop metabolic consequences during life. Obese PCOS
women with insulin resistance are carrying a risk for developing type 2 diabetes, and influencing liver function by
generating liver steatosis and nonalcoholic fatty liver disease (NAFLD). Moreover, serum testosterone of over 3
nmol/L is associated with at least two-fold higher risk for the development of NAFLD in PCOS women. Numerous
genes involved in the pathogenesis of hyperandrogenism, insulin resistance and inflammation are associated with
the development of NAFLD in PCOS women. Liver biopsy is not considered as the first line procedure for the
diagnosis of liver damage in a prevalent condition as PCOS. Therefore, simple and reliable surrogate markers as
serum aminotransferases levels or surrogate indexes (i.e. fatty liver index and NAFLD-fatty liver score) could be
used for the assessment of fatty liver in PCOS women. First line therapeutic approach for NAFLD in PCOS includes
a change in lifestyle that implies dietary regiment and physical activity but without well-defined protocols.
Second line therapy considers addition of drugs on the established lifestyle change. Metformin remains the drug of
choice for reduction of insulin resistance and liver enzymes level. Liraglutide, glucagon-like peptide-1 receptor
agonists, showed favorable effects on the reduction of liver fat content and visceral adipose tissue in overweight
women with PCOS. Current review analyzes the impact of metabolic risk factors, diagnostic approach and management
options on NAFLD in women with PCOS.
Keywords: Nonalcoholic fatty liver disease, polycystic ovary syndrome, insulin resistance, hyperandrogenism, metformin, liraglutide.
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