Clinical and laboratory predictors of hepatic steatosis formation in adolescent boys with hypoandrogenism

Abstract

Background. The established pathogenetic link between the presence of hypogonadism in males and disorders of carbohydrate and lipid metabolism makes it possible to assume the presence of pathogenetic parallels between testosterone deficiency and the formation of non-alcoholic fatty liver disease. The purpose of the study was to identify prognostic factors that contribute to the formation of hepatic steatosis in adolescent boys with hypoandrogenism (HA). Materials and methods. The study involved 157 adolescent boys with delayed puberty aged 14–18 years. The level of testosterone, γ-glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin and its fractions, blood lipids, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were determined, and an ultrasound examination of the hepatobiliary system was carried out. A system-informational analysis, the methodology of the non-homogeneous sequential Wald statistical procedure was used to determine the significant prognostic signs regarding the formation of violations of the functional state of the hepatobiliary system. Results. Patients with HA were divided into groups according to testosterone level: stage 0 hypoandrogenism — 13 (12 %), stage 1 hypoandrogenism — 18 (17 %), stage 2 hypoandrogenism — 22 (21 %), and hypoandrogenism 3 stage with the lowest content of testosterone — 53 (50 %) of adolescent boys. An increase in HA stage was associated with a tendency to an increase in the level of liver enzymes. Pathological changes in the lipid content were detected in 75 % of patients. An increase in the HOMA-IR was reliably more frequent in adolescent boys with the HA stage 3 (45 %) compared to the patients with HA stage 0 (25 %), χ2 < 0.05. Ultrasound examination revealed signs of steatohepatosis in almost a third of adolescent boys with HA. The frequency of liver enlargement in HA increased according to the stage of androgen insufficiency and was significantly higher in patients with HA stage 3 compared to those with HA stage 0 (47 and 23 %, respectively). Almost one third of adolescent boys with HA had ultrasound signs of pancreatic steatosis, regardless of the stage of androgen deficiency. Overweight or obesity, increased activity of aminotransferases, the content of low-density lipoprotein cholesterol, atherogenic index, and the presence of insulin resistance according to the HOMA-IR were identified as significant informative prognostic factors for the formation of non-alcoholic fatty liver disease. Testosterone level from 12.0 to 8.0 nmol/l turned out to be prognostically unfavorable in terms of the risk of developing hepatic steatosis. Conclusions. Prognostically significant factors for the formation of hepatic steatosis in adolescent boys with HA include the presence of insulin resistance according to the ­HOMA-IR, elevated or normal body mass index, an increase in low-density lipoprotein cholesterol level, and atherogenic index, a decrease in testosterone level, an increase in the activity of alanine aminotransferase and aspartate aminotransferase.