Podsumowanie

Ponieważ stłuszczeniowa choroba wątroby związana z dysfunkcją metaboliczną zwiększa ryzyko powikłań kardiometabolicznych i nasila zaburzenia hormonalne, wskazane jest prowadzenie badań przesiewowych w kierunku tej choroby u kobiet z PCOS. Określenie stopnia zaawansowania choroby pozwala na wdrożenie odpowiedniej terapii. Leczenie pacjentek ze stłuszczeniem wątroby i PCOS opiera się przede wszystkim na interwencjach niefarmakologicznych zmierzających ku redukcji masy ciała. Istotną rolę w zapobieganiu rozwojowi zapalenia i zwłóknieniu wątroby mogą również odgrywać leki o działaniu hipoglikemizującym, takie jak np. agoniści receptorów dla inkretyn czy inhibitory SGLT-2. Zwiększone ryzyko powikłań metabolicznych u kobiet z PCOS i ważna rola, jaką w leczeniu choroby odgrywają interwencje, takie jak: modyfikacja stylu życia, farmakoterapia otyłości i chirurgia bariatryczna, w pełni uzasadniają zmianę nazwy zespołu na PMOS.

ABSTRACT

Fatty liver disease associated with metabolic dysfunction in PCOS patients, or why we are now labelling it PMOS

Metabolic steatotic liver disease (MASLD) is currently the most common cause of chronic liver damage. In patients with polycystic ovarian syndrome (PCOS), the incidence of MASLD is almost double that of the general population, ranging from 34-70%. Insulin resistance and associated hyperinsulinemia play an important role in the common pathogenesis of both diseases, as does hyperandrogenism, which promotes fatty liver and hepatocyte dysfunction. The treatment of MASLD associated with PCOS relies heavily on maintaining a healthy lifestyle to control the body's energy balance and reduce the hyperinsulinemia associated with insulin resistance. Incretin receptor agonists such as liraglutide, semaglutide and tirzepatide are also a valuable therapeutic tool, as their use not only allows weight loss and improvement of carbohydrate metabolism, but also regression of fatty liver and inhibition of hepatic fibrosis.

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