Patient description: A 35-year-old woman presents with history of acne and mild hirsutism. The primary evaluation revealed elevated testosterone levels. She recently noticed gradual enlargement of her hands and feet and recognized that her ring is getting small for her finger. There is some irregularity in her menstrual cycle as well as some nipple discharge. She also has positive history for snoring and headache. The physical examination revealed subtle facial features of acromegaly and prognathism. Visual fields are normal by confrontation. Hirsutism, soft tissue thickening and diaphoresis of the hands and feet are noted. Laboratory evaluation in the fasting state reveals IGF-1 of 968 ng/mL and random GH of 19.7 ng/mL. MRI reveals a macroadenoma with no invasion. She is on stable doses of octreotide LAR since her diagnosis was confirmed. She is married and has 2 children. She is using IUD as her contraceptive method.

Clinical trial eligibility criteria: eligible ages (years): 18.0-45.0,  NASH - Nonalcoholic Steatohepatitis Women 18-45 years of age at Baseline Visit. 2. Documentation of NASH diagnosis confirmed on baseline liver biopsy (performed as clinical care) prior to study enrollment. 3. Written informed consent (and assent when applicable) obtained from subject and ability for subject to comply with the requirements of the study  Pregnant, breastfeeding, or unwilling to practice birth control during participation in the study 2. Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data 3. Uncontrolled diabetes (HbA1c 9.5% or higher within 60 days prior to enrollment) 4. Routine alcohol consumption >7 drinks per week during the preceding 3 months prior to baseline liver biopsy. 5. Other forms of chronic liver disease including hepatitis B virus infection (hepatitis B surface antigen positive), chronic hepatitis C virus (HCV) infection (HCV Ab and HCV ribonucleic acid positive), autoimmune disorders (e.g., primary biliary cholangitis, primary sclerosing cholangitis, and autoimmune hepatitis), drug-induced hepatotoxicity, Wilson disease, iron overload, and alpha-1-antitrypsin deficiency, based on medical history and/or centralized review of liver histology 6. Any prior or upcoming weight reduction surgery (e.g., Roux-en-Y or gastric bypass) 7. HIV infection 8. Receipt of drugs associated with NAFLD (i.e. amiodarone, methotrexate, systemic glucocorticoids, tamoxifen, anabolic steroids, valproic acid) for more than 4 weeks prior to baseline or between baseline and follow-up biopsies 9. Perimenopausal status (defined as within 3 years of self-reported menopause) due to unstable hormonal levels during that time 10. Renal impairment defined as glomerular filtration rate <45 ml/min/1.73m or potassium levels > 5.0 mmol/L due to the diuretic effect of spironolactone 11. Participation in another clinical trial of an investigational drug or device 12. History of medication non adherence as noted upon chart review or patient report of difficulty with medication adherence 13. Androgen receptor antagonist use (i.e. flutamine, spironolactone or flutamide) for more than 3 months within one year prior to baseline biopsy 14. Eplerenone use as this is a diuretic that also blocks the aldosterone receptor and could compound side effects 15. Cirrhosis on baseline biopsy as this condition leads to altered sex hormone metabolism 16. Unstable dosing (i.e. dose increase, intermittent use, or initiation) of Vitamin E anytime during the 3 months prior to baseline biopsy 17. Significant weight loss (at least 10% decrease in body weight) over preceding 3 months prior to baseline biopsy 18. Contraindication to MRI scanning (e.g. presence of permanent pacemakers, implanted cardiac devices, etc.)