ECE2024 Eposter Presentations Reproductive and Developmental Endocrinology (78 abstracts)
Defining the normative cut-off for hirsutism in unselected populations: cluster analysis
Asmamaw Bizuneh 1,2 , Anju Joham 1,3 , Chau Thien Tay 1,3 , Arul Earnest 4 , Larisa Suturina 5 , Xiaomiao Zhao 6 , Alessandra Gambineri 7 , Fahimeh Tehrani 8 , Bulent Yildiz 9 , Jinju Kim 10 , Liangzhi Xu 11 , Christian Makwe 12,13 , Helena Teede 1,3 & Riccardo Azziz 14,15,16
1Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, 3168 Victoria, Australia; 2School of Nursing, College of Health Sciences, Woldia University, 400, Woldia, Ethiopia; 3Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia; 4School of Public Health and Preventive Medicine, Monash University, 3004 Victoria, Melbourne, Australia; 5Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, 664003, Russian Federation; 6Department of Reproductive Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan 2nd Road, Guangzhou, 510080, China; 7Department of Medical and Surgical Science-DIMEC Endocrinology Unit, University of Bologna - S. Orsola-Mapighi Hospital, Italy; 8Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences Tehran, Iran; 9Division of Endocrinology and Metabolism, Hacettepe University of Medicine in Ankara, Turkey; 10Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Republic of Korea; 11Department of Obstetrics and Gynecology West China Second University Hospital Sichuan University, Chengdu 610041, China; 12Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria; 13Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria P.M.B. 12003, Surulere, Lagos, Nigeria; 14Departments of Obstetrics and Gynaecology, and Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; 15Department. of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA 35294; 16Department of Health Policy, Management, and Behaviour, School of Public Health, University at Albany, SUNY. Rensselaer, New York, USA 12144
Background: Hirsutism, characterized by the male pattern distribution of terminal hair in females due to elevated androgen levels, is a diagnostic feature for polycystic ovary syndrome (PCOS), assessed by the modified Ferriman-Gallwey (mFG) score. The 2023 international PCOS guideline suggests an mFG score of 4-6 for hirsutism detection. However, the lack of universally applicable cut-offs in diverse populations necessitates further research. Therefore, this study aimed to define ethnicity-specific normative cut-offs employing the unsupervised clustering methods (K means clustering) in unselected populations.
Methods: The study utilized data from 12,192 participants aged 12 to 80 years. Data were obtained from community-based studies that were conducted in different countries including China, Iran, Italy, Nigeria, Russia, South Korea, Turkey, and the United States of America. K means cluster analysis (k=2) and the receiver operating characteristics curve were used to determine the normative cut-offs for the mFG score. The 75th, 85th, 90th, and 95th percentiles were identified and compared between ethnicities.
Results: The mean (±SD) age of the total population was 32.7±10.7 years and the mean BMI was 24.1±5.5 kg/m2. The median (IQR) mFG score of the total population was 1 (0-3). The mFG cut-off scores vary widely across different ethnic groups, ranging from 3 to 9, with the highest scores observed among people of the Persian ethnicity (cut-off=9), followed by White Italians and Black Africans (cut-off=7), and Asian Chinese/Han and White Turkish (cut-off=5). Within the hirsute cluster, the median values for various PCOS-related parameters including mFG score, total testosterone, free testosterone, free androgen index, left ovarian volume, right ovarian volume, and menstrual cycle days (length) were significantly higher compared to the non-hirsute cluster. The finding revealed a highly statistically significant difference (P<0.001) when comparing the median mFG score, percentiles (75th, 85th, 90th, and 95th), and the mFG cut-off for each ethnic group.
Conclusions: This finding underscores the notable variation in both the distribution and the normal cut-off values for hirsutism, as determined by the mFG score, across diverse ethnicities. Notably, the highest cut-off values were observed in the Persian population, White Italians and Black Africans. The finding suggested a nuanced picture, urging clinicians to move beyond a similar mFG cut-off point and consider the unique ethnic context for optimal diagnostic accuracy in detecting clinical hyperandrogenism.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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