CHICAGO — Young women referred for polyendocrine metabolic ovarian syndrome (PMOS) had high rates of steatotic liver disease, according to new research.

The cross-sectional study of 95 young women referred to an endocrinology clinic for evaluation of PMOS (formerly called polycystic ovary syndrome [PCOS]) also found that two commonly used noninvasive screening tools failed to identify most patients with liver fibrosis.

“There was a really high rate of steatosis in women who were referred for PMOS in our population, not just those diagnosed with PMOS,” investigator Isabella Sharifi, a medical student at the University of Miami Miller School of Medicine in Miami, told Medscape Medical News.

“I think this study definitely revealed that we need better screening strategies for fibrosis,” she added.

Sharifi presented the findings at ENDO 2026: The Endocrine Society Annual Meeting.

High Rates of Steatosis

Participants had a mean age of 31.2 years and a mean BMI of 29.1; 64% had overweight or obesity. The study population was 45% White, 28% Black, 23% Asian, and 16% Hispanic. Most (89%) met the Rotterdam criteria for PMOS.

Liver steatosis, defined by a controlled attenuation parameter score > 248 dB/m on a FibroScan, was present in 40 women (42.1%). Rates did not differ significantly between women with and without PMOS (43.5% vs 30%; P = .51).

Among the 40 women with steatosis, 38 (95%) met criteria for metabolic dysfunction-associated steatotic liver disease, defined as steatosis plus a metabolic syndrome (MetS) score ≥ 1.

Liver fibrosis, defined by a FibroScan liver stiffness measurement ≥ 8.2 kPa (≥ F2), was present in six of the 95 women overall (6.3%) and in 12.5% of those with steatosis.

Steatosis was associated with older age (33.0 vs 29.8 years; P = .01), higher BMI (32.9 vs 26.2; P < .001), higher white blood cell count as a marker of systemic inflammation (8.6 vs 6.6 × 10³/µL; P < .001), higher MetS score (2.3 vs 1.1; P < .001), and greater insulin resistance as measured using Homeostatic Model Assessment for Insulin Resistance (6.2 vs 2.9; P < .001).

Hyperandrogenism, defined by elevated free testosterone levels, was also significantly more prevalent among those with steatosis than among those without (45.9% vs 14.3%; P = .002).

“Hyperandrogenism may signal underlying hepatic steatosis in young women,” Sharifi said.

Current Screening Tools Fall Short

Unlike steatosis, fibrosis did not correlate with white blood cell count or testosterone levels. Moreover, a Fibrosis-4 score ≥ 1.3 was only 17% sensitive for detecting fibrosis, although specificity was 100%. As a result, the test missed five of the six fibrosis cases.

Another tool, the Steatosis-Associated Fibrosis Estimator, developed by Stanford researchers to assess the risk for clinically significant liver fibrosis, performed only slightly better, with 40% sensitivity and 97.5% specificity. It still missed three of the five fibrosis cases identified using the FibroScan.

“Noninvasive fibrosis scores missed 60%-83% of cases in this young cohort,” Sharifi noted.

Clinicians should consider using FibroScan evaluation in patients with features such as elevated BMI and testosterone levels, she said. However, “it’s unclear what the best fibrosis screening strategy would be right now. We need age-appropriate strategies for all women with PMOS features.”

Expert Perspective

Asked to comment, session moderator Andrea E. Dunaif, MD, the Lillian and Henry M. Stratton Professor of Molecular Medicine at the Icahn School of Medicine at Mount Sinai in New York City, said the findings regarding androgen levels were particularly intriguing.

“The idea that this may be associated with androgens is very intriguing because there’s a lot of pharmaceutical interest in androgens as a specific therapeutic target for liver disease,” Dunaif told Medscape Medical News. “So it’s more than insulin resistance.”

She noted that evidence linking obesity, PMOS, and hepatic steatosis in adolescents as a function of de novo lipogenesis rather than insulin resistance was published a decade ago.

The clinical takeaway, Dunaif said, is straightforward.

“We need to be screening and thinking about fatty liver disease.”

At the same time, she agreed that the poor performance of the current fibrosis screening tools is concerning.

“These things are supposed to be predictive. I was very surprised,” Dunaif said. “So I think the question becomes: How do we screen these young women? What are the long-term implications?”

Sharifi and Dunaif reported no relevant disclosures. 

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR’s Shots blog, and diaTribe. She is on X @MiriamETucker and Bluesky @miriametucker.bsky.social.