FRI429 Association Between Nonalcoholic Fatty Liver Disease And Fib-4 In Patients With Hypogonadism

Abstract

Abstract Disclosure: C.M. Godar: None. K.F. Brown: None. A.J. Spiro: None. N.O. Vietor: None. T.D. Hoang: None. M.K. Shakir: None. Introduction: Recent studies have reported a strong bidirectional association between non-alcoholic fatty liver disease (NAFLD) and hypogonadism in both genders. Men with hypogonadism may have higher noninvasive indices of NAFLD via hepatic steatosis index (HSI, reference range <36) and hepatic fibrosis via FIB-4 (reference range <1.3). However, there is limited clinical data on the association between serum testosterone concentrations and NAFLD in men. We report here HSI and FIB-4 in 3 men with hypogonadism. Case #1: 56-year-old male with a 20-year history of idiopathic hypogonadism, hypertension on telmisartan and amlodipine, and obstructive sleep apnea with regular CPAP use. Pituitary MRI is normal. He uses 3 pumps of topical testosterone gel daily. Vital signs: BP 139/83mmHg, HR 59bpm and BMI 36.2. Examination of heart and lungs is normal, testes are 15cc bilaterally. Serum testosterone is 400-500 ng/dL, alanine aminotransferase (ALT) 88 U/L (0-50), aspartate aminotransferase (AST) 71 U/L (17-59), alkaline phosphatase (ALP) 78 U/L (38-126), iron saturation 43.1% (20-55), ferritin 452 ng/mL (30-400). Calculated FIB-4: 2.3, HSI: 46. Case #2: 71-year-old male with 46XX phenotype with hypogonadism and gynecomastia on 2 pumps of transdermal testosterone gel daily. Vital signs: BP 150/79 mmHg, HR 67/min, BMI 36.8. Examination of heart and lungs is normal, and testes are 5cc bilaterally. Serum testosterone is 416 ng/dL, ferritin 509 ng/mL, iron saturation 41.3%, ALT 19 U/L, AST 22 U/L, ALP 136 U/L. Liver ultrasound demonstrated diffuse hepatic steatosis with borderline hepatomegaly. Calculated FIB-4: 1.38, HSI: 48.4. Case #3: 48-year-old male with central hypogonadism currently taking testosterone 100 mg IM every week. Evaluation for central hypogonadism was unrevealing for pituitary lesion. Vital signs of BP 130/91, HR 76/min, BMI 27.2. Examination of heart and lungs is normal, and testes are 20cc bilaterally. ALT 201U/L, AST 80U/L, ALP 136U/L, serum testosterone 241 ng/dL. Liver ultrasound is consistent with hepatic steatosis. Calculated FIB-4: 1.22, HSI 59.2. Conclusion: Patients with a combination of hypogonadism, high BMI, mild or moderate elevations of AST/ALT/ALP, elevated serum ferritin or transferrin saturation should undergo screening for NAFLD. In this series, all 3 patients had high HSI, an early indicator of fibrosis although only 1 patient had a high FIB-4 level. As fibrosis is the strongest predictor for long-term clinical outcomes among patients with NAFLD there is growing interest in employing non-invasive methods such as HSI, FIB-4, NFS and APRI for risk stratification. In conclusion, it is recommended that high risk patients with hypogonadism need to be screened for NAFLD and hepatic fibrosis with these simple tools. Presentation: Friday, June 16, 2023