Alanine Aminotransferase Is a Marker of Lipotoxicity Consequences and Hyperandrogenemia in Women with Polycystic Ovary Syndrome

Background: Several studies have reported higher levels of Alanine aminotransferase (ALT) in women with polycystic ovary syndrome (PCOS) compared with control subjects. Plasma ALT levels are considered a marker of hepatic lipotoxicity because of their significant associations with different hepatic metabolic dysfunctions, such as hepatic steatosis and hepatic insulin resistance. Methods: Retrospective chart review aiming to assess, in PCOS women, the relationship between ALT levels and measures of lipotoxicity consequences that are available clinically, both during fasting and using the oral glucose tolerance test. Results: Women (n = 132) with PCOS, were in average 27.9 years of age, with a mean body mass index of 34.1 kg/m(2) and 49% had a metabolic syndrome (MetS). ALT levels were significantly correlated with homeostatic model assessment for insulin resistance (r=0.42, P < 0.001), HDL-C (r=-0.31, P < 0.001), Matsuda index (-0.45, P < 0.001), insulin secretion-sensitivity index-2 (-0.26, P = 0.043), and free testosterone (0.38, P < 0.001), but not with fasting glucose and triglyceride levels. ALT cutoff >= 24 IU/L was associated with all these parameters, including fasting glucose (P = 0.021) and triglyceride levels (P = 0.041), and detected more women with the MetS (59.2% vs. 36.1%, P = 0.008) and whole-body insulin resistance (Matsuda index <12.3 L-2.10/mmol(2), 85.3% vs. 51.9%, P = 0.004). Conclusions. Plasma ALT levels seem to be a strong predictor not only of liver lipotoxicity but also of systemic lipotoxic consequences and hyperandrogenemia in women with PCOS. Although it requires validation in another study, an ALT cutoff of >= 24 IU/L may help clinicians identify women with increased metabolic risks.