Hepatic manifestations of metabolic syndrome in boys with hypoandrogenism

Objective — to examine the morpho-functional state of the liver and the processes of free radical oxidation in boys with hypoandrogenism. Materials and methods. The study involved 47 adolescents with hypoandrogenism aged 13—18 years, who underwent a set of standard and special clinical and laboratory examination on the basis of the department of endocrinology SI «Institute of Children and Adolescents Health Care of the NAMS of Ukraine». Patients with hypoandrogenism were divided into groups depending on the index of masculinization. Mathematical processing of the study results was carried out using software packages SPSS Statistics 17.0, Excel. Results and discussion. It was found that complaints of abdominal pain and dyspeptic symptoms were observed in 62 % of cases. The conventional biochemical testing of liver function determined that the average levels of total bilirubin and liver enzymes were within normal range, suggesting that boys with hypoandrogenism probably had no significant violations of the functional state of the liver yet. Analysis of the lipid profile of children and adolescents with hypoandrogenism revealed that 75 % of patients had pathological changes in lipid levels, including 85 % with increased total cholesterol, 34 % with decreased HDL cholesterol and increased TG, 34 % with increased LDL cholesterol, 36 % with increased atherogenic coefficient. Atherogenic­chan­ges in the lipidogram increased with age. The study of indicators of free radical oxidation process revealed that in boys with hypoandrogenism the level of the final product of lipid peroxidation — malondialdehyde remained at the level of the control group, and the level of carbonated proteins tended to decrease with the increasing in the degree of delayed puberty. A significant reduction of the glutathione peroxidase level respectively to the deficiency of androgens was found. Thus, in adolescents with hypoandrogenism, a tendency towards the formation of the state of oxidative stress was revealed, which is confirmed by an increase of the integral coefficient of oxidative stress. Reducing the activity of the most powerful part of antioxidant system, in particular enzymatic, can lead to a «second hit» in the formation of non­alcoholic fatty liver disease and contribute to the transformation of liver steatosis into steatohepatitis. The results of ultrasound examination indicated the presence of functional disorders of the biliary tract in all boys with hypoandrogenism, and in one third of patients there were clear signs of steatohepa­tosis and gallstone disease. Conclusions. The results of the study indicated the formation of comorbid pathology of the hepatobiliary system in boys with hypoandrogenism. In 30 % of patients, ultrasound signs of steatohepatosis, atherogenic dyslipidemia and inhibition of antioxidant defense in the form of a significant decrease in the activity of glutathione peroxidase were detected. The results of the study indicate the necessity of inclusion in the diagnostic algorithm in boys with hypoandrogenism indicators of lipidogram, ultrasound of the liver and biliary tract, as well as the development of protocols for the prevention of hepatobiliary pathology, including the use of dietary correction, the prescription of hepatoprotectors with antioxidant activity, choleretic drugs.