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Endocrine Abstracts (2016) 44 P220 | DOI: 10.1530/endoabs.44.P220

SFEBES2016 Poster Presentations Reproduction (33 abstracts)

Management of Turner’s syndrome women with liver involvement: FIB-4 score is a promising marker of fibrosis

Matilde Calanchini 1 , Ahmad Moolla 1 , Jeremy W Tomlinson 1 , Jeremy Cobbold 2 , Andrea Fabbri 1 , Ashley Grossman 1 & Helen Turner 1


1Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, University of Oxford, Oxford, UK;
2Translational Gastroenterology Unit, Department of Gastroenterology and Hepatology, John Radcliffe Hospital, University of Oxford, Oxford, UK.

Introduction: Liver involvement is frequent in Turner’s syndrome (TS). We have shown that 35% TS women have elevated liver function tests (↑LFTs). Most common hepatic changes include steatosis and steatohepatitis; however, progression to advanced fibrosis and cirrhosis is reported. This study assessed a simple noninvasive test for liver fibrosis, FIB-4, which combines standard biochemical values (platelets, ALT, AST) and age in order to evaluate its diagnostic performance in TS.

Methods: From a total of 104 patients attending our dedicated adult TS-clinic, we selected cases corresponding to the following criteria: 1) laboratory assessments allowing FIB-4 calculation; 2) absence of heavy alcohol consumption; 3) absence of other liver comorbidities. Karyotype, clinical and metabolic data were collected. A FIB-4 >1.3 was used, as a validated cut-off of increased risk of advanced fibrosis. Comparisons between FIB-4, liver biopsy and noninvasive (serologic and morphologic) markers of fibrosis were performed.

Results: Fifty-nine women, including 26 with ↑LFTs had a FIB-4 evaluation. FIB-4 scores ranged between 0.24 and 3.03, median 0.68. In the ↑LFTs-group median was 0.84 (range 0.4–3.03). Strong correlations were found between FIB-4 and GGT (P=0.009), ALP (P=0.005), duration of ↑LFTs (P=0.002) and AST-Platelet-Ratio-Index (P=0.001). FIB-4 was >1.3 in 9 women, 7 with ↑LFTs. Of these, one (FIB-4 1.3), Fibroscan 8.9 kPa (>7 kPa suggestive of fibrosis, >11 kPa of cirrhosis) and MRCP showing poor intrahepatic filling. One (FIB-4 1.48) had a biopsy finding of periductal fibrosis and one (FIB-4 3.03) Fibroscan 30.1 kPa and biopsy showing cirrhosis. The other patients were referred for Fibroscan. Biopsy was performed in 3 women with normal FIB-4, but ↑LFTs: none of which demostrated fibrosis.

Conclusions: Comparison between FIB-4 and liver biopsy showed a high concordance, suggesting that FIB-4 may be a useful noninvasive tool to screen for significant fibrotic liver disease in TS women and exclude those who do not require biopsy.

Volume 44

Society for Endocrinology BES 2016

Brighton, UK
07 Nov 2016 - 09 Nov 2016

Society for Endocrinology 

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