mFG Score Research Articles

The impact of androgen levels on serum metabolic profiles in patients with polycystic ovary syndrome

Objective This study aimed to investigate the impact of serum androgen levels on metabolic profiles in patients with polycystic ovary syndrome (PCOS). Methods We included 216 patients with PCOS and 216 healthy individuals selected as the control group. According to the measured serum androgen levels, patients with PCOS were divided into the hyperandrogenism group and non-hyperandrogenism group. Clinical metabolic indicators were assessed and compared between the two groups. Additionally, we assessed the correlation between androgen levels and clinical metabolic indicators. Results The body mass index, waist-to-hip ratio, mF-G score, and acne score, as well as T, LH, LSH/FSH, FPG, Cr, UA, TG, TC, and LDL-C levels were significantly higher in the PCOS group than in the control group. The incidence of hyperandrogenism and clinical hyperandrogenism in the PCOS group was significantly higher than that in the control group. Regarding clinical hyperandrogenism, hirsutism, acne, and acanthosis nigricans were significantly more common in the PCOS group than in the control group. Serum androgen levels were significantly correlated with the mF-G score, acne score, FSH, glucose concentration at 30 min, glucose concentration at 60 min, glucose concentration at 120 min, FINS, N120, HOMA-IR, HbA1c, AUCG, UA, TG, and hHDL-Clevels. Conclusion Elevated serum androgen levels are commonly observed in patients with PCOS and are associated with multiple metabolic abnormalities. Therefore, it is recommended to regularly monitor glucose and lipid metabolism-related indicators in patients with PCOS who have elevated androgen levels.

Physician and Adolescent Hirsutism Score Ratings and Their Concordance to Androgen Levels [ID 2683618

INTRODUCTION: Hirsutism affects 5–15% of reproductive-aged women. The gold standard for quantifying hirsutism is the modified Ferriman–Gallwey (mFG) score. This study explores whether adolescent and physician ratings of hirsutism using the mFG score, correlate with androgen levels in the setting of confounders like depilation. METHODS: Hispanic adolescent females with irregular menstruation and suspected polycystic ovary syndrome (PCOS) were recruited from obstetrics and gynecology clinics at TTUHSC El Paso between September 2021 and May 2023. Patients completed an intake questionnaire, completed PCOS laboratory testing, and rated their hair growth using the mFG visual scoring method. Providers used same the methods for rating hirsutism during the same visit. We estimated Lin’s concordance correlation and Bland–Altman agreement between patient and provider mFG ratings. Linear regression explored factors affecting score changes. Statistical analysis was done by STATA 17.0. RESULTS: Forty females participated in this study. The average age at enrollment was 16.19 with a mean (SD) mFG score of 10.55 (5.95) (physicians) and 18.29 (5.78) (adolescents). Adolescents reported higher mean mFG scores than physicians. There is a low level of agreement between the two groups (−7.95; 95% CI: −23.02, 7.12). Specifically, physicians underrated hirsutism scores for arm hair. Using unadjusted linear regression, DHEAS and 17-hydroxyprogesterone levels demonstrate the hormonal influence on hirsutism. CONCLUSION: Preliminary findings indicate discordance between physicians’ and patients’ mFG scores, possibly influenced by examination precision and patient perception. Physician-scored mFG, and evaluation of androgen levels, may serve as precise hirsutism markers for Hispanic adolescents.

Modified ferriman-gallwey score and hirsutism among normal healthy female population.

This study aimed to investigate the prevalence of Hirsutism by using the mFG score and to identify the mean mFG score among the normal healthy female population of Peshawar. A cross-sectional study was conducted among 448 normal healthy married women aged between 20 to 40 years from 14th April 2022 to 13th October 2022 at Hayatabad Medical Complex in Peshawar. The mFG score was used to evaluate Hirsutism, a score of eight or above was regarded as indicative of Hirsutism. The mean modified Ferriman-Gallwey (mFG) score was 8.89 ± 4.33. 255 (56.9%) of the individuals had a mFG score of more than 8. These people showed mild hirsutism in 52.0% of cases, moderate hirsutism in 4.5% of cases, and severe hirsutism in 0.4% of cases. It was observed that the lower abdomen and thigh region had the highest prevalence of mild to moderate hirsutism, with a considerable number of individuals scoring two and three. Conversely, the back and buttocks showed predominantly minimal to no hirsutism, with the majority of participants scoring 0 and 1. There was no discernible difference in mean mFG scores between age groups, according to statistical analysis (p=0.195). Intriguingly, rates of hirsutism were found to be higher in urban versus rural populations, at 78.7% versus 36.6%, respectively (p<0.01). In addition, 80.3% of people who had a positive family history of hirsutism had a mFG score of 8 or higher. The prevalence of Hirsutism among the normal healthy female population based on the mFG score was relatively high.

Clinical and Biochemical Evaluation of Hirsutism in Young, Lean Girls from Kirkuk City, Iraq: A Cross-Sectional Study

Background: An increase in terminal hair in androgen-dependent regions is known as hirsutism. It is not solely caused by hyperandrogenemia; idiopathic forms are also frequently seen. Objective: To examine the modified Ferriman Gallwey (mFG) cut-off score in female Iraqis as well as the etiological, biochemical, and clinical characteristics of hirsutism. Methods: This prospective cross-sectional study included one thousand young girls with a normal BMI. The features associated with clinical hirsutism were identified using the mFG scoring system. We eliminated eighty-eight young girls who were diagnosed with PCOS. Samples of blood were drawn for biochemical analyses. Results: 53.1%, 19.6%, and 1.2% of females had mild, moderate, or severe hirsutism, respectively. For the young females who participated in the study, their mean mFG scores were 7.07, 11.26, 16.26, and 29, respectively. Only 5% of girls with mild hirsutism had high serum free testosterone levels, despite a considerable difference in free testosterone levels between them and the normal girls. The chin, upper lip, and lower abdomen were the sites that contributed the most to mFGs. Of the girls who were moderately hirsute, 55% had a positive family history of hirsutism. Conclusion: Iraqi women do not need to consider the mFG score system's cut-off number of 8. The endocrine society's guidelines for hirsutism estimation should be adhered to by the examiner.

THU649 PCOS Phenotype In Unselected Populations (P-PUP) Study: Defining And Comparing Hirsutism Across Various Ethnic Groups In Unselected Populations

Abstract Disclosure: S. Kiconco: None. A.E. Joham: None. L.V. Suturina: None. X. Zhao: None. A. Gambineri: None. F.R. Tehrani: None. B.O. Yildiz: None. J. Kim: None. H.J. Teede: None. R. Azziz: None. Introduction Hirsutism is defined as the male pattern distribution of terminal hair in a female. It is one of the diagnostic features of polycystic ovary syndrome (PCOS), reflecting clinical hyperandrogenism, as measured by the modified Ferriman-Gallwey score (mFG). However, whether the mFG scores and the normative cut-off varies by ethnicity is unclear. We aimed to describe and compare the distribution of mFG score in different ethnic groups from eight countries using data from unselected (medically unbiased) populations to determine and compare the normative cut-off values between the different ethnic groups and the prevalence of hirsutism thereby defined. Methods We utilised data of 10,919 participants aged 15 to 80 years. Data were obtained from epidemiologic studies assessing unselected women conducted in different countries including China, Iran, Italy, Nigeria, Russia, South Korea, Turkey, and the United States of America. The distribution of mFG between ethnic groups was determined descriptively as medians. Cluster analysis (k means, k=2) and the receiver operating characteristics curve were used to determine the normative cut-offs for the mFG score. All medians, cut-offs and percentile values were compared between ethnic groups using the Kruskal-Wallis test at a 95% level of significance. Results Our data consisted of 11 ethnic groups from 8 countries. The Persian (4.8±4.7) and Italian (4.8±4.7) populations had higher median mFG scores than the rest of the ethnic groups, whilst Asian populations (Chinese, Korean and Buryat) had the lowest scores. Overall, the median distribution of mFG differed significantly by ethnicity. Using cluster analysis, the mFG cut offs range from 4 to 9, with the Persian ethnic group having the highest, followed by the Italian group, with cut-offs differing by ethnicity overall; however cut offs are similar for Black American, Turkish, Asian and Russian groups. Conclusion The distribution and normal cut off values for hirsutism differ significantly by ethnicity, with the Persian population having the highest cut offs. Ethnicity needs to be considered when assessing women for clinical hyperandrogenism. Presentation: Thursday, June 15, 2023

SAT377 Revisiting The Utility Of Simplified Ferriman-Gallway Score (Sfg) To Predict Hirsutism In Brazilian Women

Abstract Disclosure: T.F. Oliveira: None. T. Oliveira: None. K.L. da Penha: None. D.C. Santana: None. A.L. Rocha: None. F.M. Reis: None. M.O. Premaor: None. A. Candido: None. F.V. Comim: None. Hirsutism is a common condition in women, being a hallmark of polycystic ovary syndrome (PCOS). Currently, the unique way to determine hirsutism is through the modified Ferriman Gallway score (mFG) based on the analysis of nine body areas. Establishing the mFG score also requires a trained observer, a well-lit room, and time to perform a satisfactory examination. Due to these requirements, alternatives have been proposed. Our study investigated the performance of the simplified Ferriman-Gallwey (sFG) hair growth scoring system, as proposed by Cook et al. (2011). sFG includes only three areas of mFG (cheek, upper and lower abdomen) identifying hirsutism when the score is equal or superior to 3. Since the presence of hirsutism depends on the ethnical background, we explored the performance of sFG to predict the diagnosis of hirsutism in Brazilian women. This study was approved by the local ethics committee. Women at reproductive age were recruited from the Endocrine and Gynecologic outpatient clinics. Clinical and anthropometric data were obtained; two independent observers performed the modified FG score. Hirsutism was defined as mFG &amp;gt; 6 for South Americans [the criteria suggested by the Endocrine Society (ES)] or mFG &amp;gt; 4 [European Society of Human Reproduction and Embryology (ESHRE)]. Overall, 199 women were evaluated. The (mean + SEM) for age was 33.7 + 0.7 years, BMI 29.8 + 0.5 kg/m2, Abdominal circumference 92.4 + 1.2 cm, total mFG score 2.8 + 0.2. The frequency of ethnic background was 20.8% for whites, 28.7% for blacks, 47.8% for multiracial, and 2.7% for others (e.g., indigenous). The prevalence of the established diagnosis of PCOS was 24.6%. When inquired, 50% of the group (n=98) complained of excessive hair growth. Our results confirmed by multiple linear regression (Adjusted R2=0.986; p&amp;lt;0.001) that the best five predictors for mFG score were the upper abdomen, cheek, lower abdomen, thorax, and upper lip. When using the criteria of ES (mFG &amp;gt; 6) (n=147), the sensibility and CI of sFG was 76.9%, (95% CI =56.4-91.0%), and the specificity 95.0%, (95%CI =89.5-98.2%) with an accuracy of 91.8% (95% CI= 86.2 – 95.7%). The positive predictive value (PPV) was 76.9%, and the negative predictive value (NPV) was 95.0%. Using the criteria for diagnosing hirsutism by ESHRE (mFG &amp;gt; 4) (n=188), the sensibility and CI of sFG was lower 55.6%, (95% CI 40.0-70.4%), and the specificity higher, 97.2% (95%CI 93.0-99.2%) with an accuracy of 87.2% (95% CI 81.6 – 91.6%). The PPV was 86.2% and the NPV of 87.4%. Our results in South American women replicated those reported in the largest study performed in a predominant white ethnicity (approximately 70%) in the US. From our point of view, as a screening or as a substitutive tool, the sFG below three can exclude hirsutism with a reasonable negative prediction; nevertheless, more studies need to be performed in the clinical setting. Presentation Date: Saturday, June 17, 2023

Comparison of Modified Ferriman-Gallwey Score and Biochemical Parameters in the Estimation of the Prevalence of Idiopathic Hirsutism Among Women in the Kurdistan Region

The word "hirsutism" describes the development of terminal hairs at androgen-controlled body locations in women, which has distress and adverse psychosocial affects. The diagnosis of hirsutism is the key point in the treatment of unwanted hair growth in women’s body. Present study aimed to evaluate the modified Ferriman-Gallwey (mFG) score and the biochemical hyperandrogenism parameters among Iraqi hirsute women and their association with hirsutism in outpatients clinics in Kalar city, Garmian region, Iraq. This was a cross-sectional study of 100 hirsute women were collected from the outpatients clinic and 26 healthy women in Kalar city. After detailed history taking by using structured questionnaire, physical examination, and the relevant investigations were done, the scoring of hirsutism was indexed according to (mFG) scoring system. Moreover, sera of hormonal markers were measured; which included 17-hydroxyprogesterone (17-OHP), total testosterone (TT), free testosterone (FT), dehydroepiandrosterone (DHEA), s. prolactin, and thyroid stimulating hormone (TSH). No statistically significant differences were found in the median of the sex and related hormones between control subjects and the hirsutism group. Likewise, there were no significant relation between hormonal markers and the rate of hirsutism. While, an intrinsic statistical association was seen between the mFG score with the hirsutism and the rate of hirsutism. Our findings imply that the mFG score system is a significance screening tool and has tremendous importance and utility in establishing the diagnosis of hirsutism.

Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set.

Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes. Prospective observational study. In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup. The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.

Vitamin D supplementation in the treatment of polycystic ovary syndrome: A meta-analysis of randomized controlled trials

BackgroundVitamin D level is closely associated with the development of polycystic ovary syndrome (PCOS). We aimed to systematically evaluate the effects of vitamin D supplementation on patients with PCOS, to provide reliable evidence to the clinical treatment of PCOS. MethodsWe searched PubMed, Medline, EMbase, Cochrane Library, Web of Science, WanFang, China national knowledge infrastructure(CNKI) and Weipu databases for randomized controlled trials (RCTs) on vitamin D supplementation for the treatment of PCOS. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included RCTs. RevMan 5.3 software was used for meta-analysis. Results13 RCTs with 840 PCOS patients were included finally. Meta-analyses indicated that vitamin D supplementation increase the serum vitamin D level[mean difference(MD) = 17.81, 95% confidence interval(CI) (10.65, 24.97)] and endometrial thickness [MD = 1.78, 95%CI (0.49, 3.06), P = 0.007], reduce the serum hs-CRP [MD = −0.54, 95%CI (−1.00, −0.08)], parathyroid hormone[MD = −14.76, 95%CI (−28.32, −1.19)], total cholesterol[MD = −12.00, 95%CI (−18.36, −5.56)] and total testosterone level [MD = −0.17, 95%CI (−0.29, −0.05)] (all p < 0.05). No significant differences in the SHBG level [MD = 1.33, 95%CI (−2.70, 5.36)] and mF-G score [MD = 0.04, 95%CI (−0.79, 0.86)] between vitamin D and control group were found (all p > 0.05). Egger's tests showed that there were no publication biases in every synthesized result (all P > 0.05). ConclusionVitamin D may be helpful to improve the endocrine and metabolism-related indexes in patients with PCOS. More high-quality studies with larger sample size are warranted to further evaluate the role of vitamin D supplementation in patients with PCOS.

Prevalence of polycystic ovary syndrome under NIH criteria among the tenth-grade Chinese schoolgirls in Guangzhou area: a cross-sectional epidemiological survey

BackgroundPolycystic ovary syndrome (PCOS) is currently considered to have a peri-adolescence onset and continuously influence the reproductive and metabolic health of the patients, while the diagnostic criteria among adolescent population haven’t been universally unified till now. This survey seeks to preliminarily evaluate the prevalence of PCOS in the tenth grade schoolgirls in Guangzhou area under NIH criteria and analyze the clinical features of adolescents with PCOS.MethodsThe cross-sectional epidemiological survey was carried out among the tenth grade schoolgirls in Guangzhou area by the method of cluster sampling. The contents of this survey included the questionnaire, physical exams and serum measurements. Until now, totally 1294 girls underwent this survey and 1095 serum samples were restored. 235 non-hirsute (mFG < 6), postmenarcheally 2-year girls were randomly selected as the control group, among which the cut-off value of biochemical hyperandrogenemia was set accordingly. The prevalence of PCOS among this population was preliminarily evaluated according to the NIH criteria.ResultsAlong with the increase of gynecological age, the menstruations of girls was becoming more regular and the incidence of oligomenorrhea or amenorrhea was declining. Even among those who were less than 2 years after menarche, those whose menstrual cycle were longer than 90 days accounted for lower than 5%. The 95th percentile of mFG score was 6 among the girls who were < 2 years after menarche, and 5 among the girls who were > 2 years after menarche. Among the 235 healthy girls, the 95th percentile values of Testosterone (T), Free androgen index (FAI) and Androstenedione (A2) were 2.28 nmol/mL, 4.37, and 5.20 nmol/mL respectively. Based on the NIH criteria, the prevalence of PCOS in this survey was 3.86%. The prevalence of adolescent PCOS tend to slightly increase with age and gynecological age, but the difference was not statistically significant. The prevalence of PCOS among obese girls was markedly higher than that in lean girls.ConclusionBased on the NIH criteria, the prevalence of PCOS among the tenth grade schoolgirls in Guangzhou area was 3.86%. The diagnosis of hyperandrogenism among adolescents should also be based on both clinical and biochemical parameters.

Comparison of image-based modified Ferriman-Gallway score evaluation with in-person evaluation: an alternative method for hirsutism diagnosis.

The gold standard for diagnosing hirsutism is based on the modified Ferriman-Gallway (mFG) score, requiring trained and in-person evaluation. Our study aimed to evaluate whether using mobile phone images of the nine mFG areas could offer an alternative way to support the diagnostic of hirsutism. All patients from an endocrine outpatient clinic underwent an initial mFG evaluation by two blinded, trained examiners. Then, images of the nine mFG areas were acquired using a mobile device (48 MP) under standard conditions and artificial illumination. A cutoff mFG score of ≥ 4 (suggested by European Society of Human Reproduction and Embryology) or ≥ 6 (proposed by The Endocrine Society) has been established as the criteria for diagnosing hirsutism. After storage, the individual patients' images were submitted for mFG analysis by three independent, blinded examiners. Overall, 70 females were evaluated; 27.5% of the patients had an mFG score ≥ 4. The mean age ± SEM was 33.2 + 1.13years. The first consideration was the evaluation of the examiners who analyzed the images. In this group, the inter-rater reliability based on the Fleiss' Kappa identified an agreement of 81.4%, with a Kappa index of 0.75 considered strong for clinical evaluations. For mFG score ≥ 6, the agreement was 77%, and the performance of Kappa Index was 0.62 (moderate). Independently of the cutoffs, the Bland-Altman analysis established a concordance of 0.89 (95% CI [0.83, 0.92]) between the in-person and image-based methods to score mFG. The lower limit of agreement of the estimated mFG scores was -2.08 (95% CI [-2.73, -1.43]), and the upper limit of agreement was 4.14 (95% CI [3.491, 4.79]). We observed acceptable concordance between the image-based and in-person evaluation of mFG scores. Our results support the use of image acquisition of mFG areas as a valid approach for diagnosing hirsutism.

PMON247 Prevalence of Polycystic Ovary Syndrome in Eastern Siberia: a Cross-Sectional Study.

Abstract Background There is a lack of data on the prevalence of PCOS and its phenotype in many geographic regions. Siberia is a unique region of the Russian Federation with a multi-raced population living in similar geographic and socio-economic conditions for centuries. Therefore, we considered this population optimal for epidemiological research. Objectives To determine the prevalence of PCOS and the PCOS phenotypes in unselected women in the Eastern Siberia region. Population: We performed the institution-based, cross-sectional Eastern Siberia PCOS Epidemiology &amp; Phenotype (ESPEP) Study during 2016-2019 (СlinicalTrials.gov ID: NCT05194384) and recruited 1148 premenopausal women aged 34.3±6.3 yrs., of which 63.2% were Caucasians, 27.6% Asians, and 9.2% Mixed-race. All subjects provided written informed consent. Exclusion criteria were: current pregnancy or lactation, history of hysterectomy, bilateral oophorectomy, endometrial ablation, uterine artery embolization; and current or previous hormonal medications or insulin-sensitizers intake. The study was approved by the Institutional Ethics Committee of the Scientific Center for Family Health a Human Reproduction (Irkutsk, Russian Federation). Methods include questionnaires, anthropometry, vital signs, gynecological examination, mF-G scoring, pelvic U/S, and blood sampling. For PCOS diagnosis we used the Rotterdam (2003) criteria. Serum samples were analyzed for total testosterone (TT) using LC-MS/MS. DHEAS, SHBG, prolactin, TSH, and 17-OHP were assessed by ELISA. Free Androgen Index (FAI) was calculated (i.e. [TT/SHBG]×100). The upper normal limit (UNL) for the mF-G score was 4, as determined using a 2k-cluster analysis in the total study population. The upper normal limits (UNL) for androgens were determined from the 98th percentiles for these parameters in 143 women, identified as the "super-controls". Pearson Chi-square and Fisher exact one-tailed tests were used to comparing proportions and categorical variables. A p-value of 0.05 was considered statistically significant. Results The total prevalence of PCOS in premenopausal women from Eastern Siberia was estimated as 13.3%, with the following distribution of PCOS phenotypes: 29.1% (A), 9.9% (B), 26.2%(C), and 34.8% (D). There was no significant difference in PCOS prevalence by race: 13.4% in Caucasians, 11.0% in Asians, and 19.8% in Mixed race women (pχ2=0.07). Classic PCOS phenotype A was found in a comparable number of PCOS women (28% in Caucasians, 31.2% in Asians, and 30% in Mixed race); whereas Asian PCOS patients demonstrated the highest proportion of phenotype B (25% vs 5.6% in Caucasians and 5% in mixed-race). The number of hirsute women (with mF-G score &amp;gt;4) was dependent on race and reached 22%, 29%, and 36% among Caucasians, Asians, and mixed-race women, respectively (p χ2=0.001). Conclusions The results of the ESPEP study, conducted in a multi-race unselected population of premenopausal women from Eastern Siberia demonstrated a 13.3% total prevalence of PCOS and race-dependent difference in the clinical manifestation of PCOS. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

PMON248 Predictive value of markers of hyperandrogenism in 1610 women with PCOS

Abstract Polycystic ovary syndrome (PCOS), an endocrine disorder that affects 10% of women worldwide. In 1990, the NIH established the first consensus on diagnostic criteria for PCOS which included chronic anovulation with clinical and/or biochemical hyperandrogenism, after the exclusion of related disorders. Traditionally the assessment of hyperandrogenism included serum studies of total testosterone (TT), free testosterone (FT), and dehydroepiandrosterone sulfate (DHEA-S), and physical exam assessing hirsutism using the modified Ferriman-Gallwey (mFG) score. The most recent 2018 International Guidelines suggest the measurement of DHEA-S can be considered if TT or FT are not elevated, but probably provide limited diagnostic value. We evaluated the diagnostic utility of TT, FT, DHEA-S and hirsutism in a large prospective cohort of PCOS women. Subjects presented to tertiary-care specialty clinics with symptoms of androgen excess in Birmingham, Alabama and Los Angeles, California from 1987-2010. Clinical hyperandrogenism was assessed using the mFG score, and hirsutism was defined as mFG &amp;gt;4. Participants underwent serum studies to assess for hyperandrogenemia and exclude other causes of hyperandrogenism. Fasting blood samples were obtained on cycle days 3 through 8 of a spontaneous or progesterone-induced vaginal bleed for measurement of TT, FT and DHEA-S. Elevated serum androgens were defined as values exceeding the laboratory reference range or greater than the 95th percentile of reported values. Subjects were considered to have oligomenorrhea if they reported &amp;gt;35 day cycles, &amp;lt;10 bleeds per year or reported being eumenorrheic but were confirmed non-ovulatory with a luteal phase progesterone &amp;lt;4 ng/mL. One thousand six hundred and ten women and adolescents (n=1610), aged &amp;gt; 14 years, were diagnosed with PCOS by NIH Criteria and included. Of these 1610 subjects, 39.3% (n=643) were diagnosed with PCOS based upon an elevated TT and FT with oligomenorrhea; 23.9% (n=384) based upon an elevated TT, normal FT and oligomenorrhea; 11.3% (n=182) based upon an elevated FT, normal TT and oligomenorrhea; 1.1% (n=17) based upon oligomenorrhea with normal TT, normal FT and elevated DHEA-S; and 23.9% (n=384) based upon normal serum androgens, oligomenorrhea, and hirsutism (mFG&amp;gt;4). Results suggest that the diagnosis of PCOS is rarely made based upon elevated DHEA-S in the setting of normal TT and FT. Most women had elevated TT and/or FT values, but still a significant proportion (23.9%) of women were diagnosed with PCOS based upon hirsutism in the context of normal serum androgens. Thus, an assessment of hirsutism, which is both timely and inexpensive, is a strong predictor and valuable tool in diagnosing PCOS, reserving DHEAS when better measures of hyperandrogenism are not diagnostic. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

PMON244 Alterations in Nonesterified Free Fatty Acids (NEFA) Trafficking Rather Than Hyperandrogenism Contribute to Variations in Insulin Sensitivity Among Obese Women with Polycystic Ovary Syndrome

Abstract Objectives To compare the metabolic and hormonal features of metabolically unhealthy obese PCOS women (MU-PCOS) vs. metabolically healthy obese PCOS women (MH-PCOS) and determine whether alterations in non-esterified free fatty acids (NEFA) response to hyperinsulinemia contribute to variations in insulin sensitivity between MU-PCOS and MH-PCOS. Design Prospective cross-sectional study. Setting Tertiary-care academic center. Methods Insulin resistance (IR) in the basal state was assessed by HOMA-IR in 125 consecutive obese oligo-ovulatory PCOS women (BMI≥ 30 kg/m2; NIH 1990 or Rotterdam 2003 Phenotype A/B) undergoing an oral glucose tolerance test (oGTT); and IR in the dynamic state assessed by the modified frequently sampled intravenous glucose tolerance test (mFSIVGTT) in a subgroup of 16 non-diabetic obese PCOS women. Main Outcome Measures: Primary outcome measures were: 1) IR in AT was assessed in the basal state by the Adipose Insulin Resistance Index [Adipo-IR]) and dynamically by the mFSIVGTT-derived indices of insulin-mediated NEFA suppression [NEFAnadir, TIMEnadir, and %NEFAsupp]); 2) peak lipolysis rate [SNEFA]; and 3) peak NEFA uptake rate [KNEFA]. Secondary outcome measures were levels of insulin and glucose during oGTT, HOMA-β%, and degree of hyperandrogenism (i.e. mF-G score, free testosterone [T], total T, DHEAS). Results Eighty-five obese PCOS participants undergoing oGTT had a HOMA-IR index of ≥2.5 (MU-PCOS) and 40 had a HOMA-IR of &amp;lt;2.5 (MH-PCOS). MU-PCOS had higher mean HOMA-β%, levels of fasting, 1-hr and 2-hr. glucose and insulin, and peak insulin during the oGTT, and higher prevalence of prediabetes and elevated 1-hr. glucose and a trend towards higher prevalence of type 2 diabetes mellitus (T2DM), than MH-PCOS. Alternatively, measures of HA were similar between the groups. Assessing IR dynamically, subjects were subdivided into MU-PCOS by an insulin sensitivity index [Si] ≤1.7 [mU/L]−1·min−1 (n=8) or MH-PCOS by an Si ≥5.6 [mU/L]−1·min−1 (n=8), matched for age and BMI. MU-PCOS had lower Si and KNEFA, smaller %NEFAsupp, longer TIMEnidar, and higher NEFAnidar and Adipo-IR than MH-PCOS, although fasting plasma NEFA levels and SNEFA were similar. In bivalent analysis, Si correlated strongly and negatively with NEFAnadir, weakly and negatively with TIMEnadir, and positively and strongly with KNEFA and NEFAsupp, in MUO-PCOS only. Conclusion Independent of age and BMI, metabolically unhealthy obese PCOS women, compared with metabolically healthy obese PCOS women, had lower rates of NEFA uptake and altered insulin-mediated plasma NEFA suppression in response to mFSIVGTT-determined endogenous insulin secretion, rather than disparities in HA and rate of lipolysis, mechanism that may contribute to variations in insulin sensitivity among obese PCOS women. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

PMON245 Clinical Phenotypes of Polycystic Ovary Syndrome (PCOS) in Nigerian Women: Preliminary Results of the Nigeria PCOS Epidemiology &amp; Phenotype (Nigeria-Pep) Study

Abstract Background Although the phenotype of polycystic ovary syndrome (PCOS) is heterogeneous, there is paucity of data on the prevalence and phenotype of PCOS in sub-Saharan Africa. Methods We studied 75 consecutive consenting women, aged 18-45 years, who presented with features suggestive of PCOS. A standardized proforma was used to obtain relevant information. Anthropometric measurements were determined, and terminal hair growth was assessed using the modified Ferriman-Gallwey (mF-G) method. All subjects underwent an oral glucose tolerance test (OGTT) and pelvic ultrasonography on day 2-7 of the menstrual cycle. An mF-G score of ≥ 6 was regarded as evidence of clinical hyperandrogenism (HA). Menstrual dysfunction (MD) was defined as menstrual cycle lengths &amp;gt;35 or &amp;lt;25 days. Polycystic Ovarian Morphology (PCOM) was defined as an antral follicle count (AFC) of ≥12 2-9 mm follicles and/or an ovarian volume ≥10 cm3, in at least one ovary. Results The mean (SD) age of the study population was 28.6 (5.8) years, and the mean (SD) body mass index (BMI) was 26.3 (5.6) kg/m2. Three (4.0%) participants were underweighted, 27 (36.0%) had normal BMI, 30 (40%) were overweight, and 15 (20.0%) were obese. The mean (SD) systolic and diastolic blood pressures were 107.4 (12.6) mmHg and 72.6 (8.2) mmHg, respectively. OGTT results indicated that the mean (SD) fasting blood glucose was 86.6 (10.6) mg/dl and the mean (SD) 2-hr. postprandial glucose was 109.8 (22.2) mg/dl. Two women had impaired glucose tolerance and one had type 2 diabetes mellitus. Of the 75 subjects recruited, 26 (34.7%) had HA, 54 (72.0%) had MD, and 63 (84.0%) had PCOM. Of all subjects, 20 (26.7%) had HA+MD+PCOM, consistent with PCOS Phenotype A; one (1.3%) had HA+MD only, consistent with Phenotype B; four (5.3%) had HA+PCOM only, consistent with Phenotype C; and 28 (37.3%) had MD+PCOM only, consistent with Phenotype D. In 22 (29.4%) no evidence of PCOS was found. Overall, our results indicate that of subjects evaluated clinically, 53 (70.6%) had PCOS. Conclusions Our preliminary results indicate that in a referral (clinical) population in Lagos, Nigeria, using only the clinical presentation without circulating androgen measures, PCOS was detected in two-thirds, with Phenotype D (aka, 'non-hyperandrogenic PCOS’) being the most common presentation (53%), followed by Phenotype A (aka 'classic or full PCOS’) observed in 38% of all women with PCOS seen. However, as 72% of all subjects had MD and 63% had PCOM, many more of these women could have been diagnosed with PCOS if the presence of hyperandrogenemia could have been demonstrated. Overall, these observations suggest that accurate measurement of circulating androgen, lacking in many parts of Sub-Sahara Africa, may be critical to accurately detecting PCOS in that region. Studies are ongoing. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Hirsutism and Quality of Life of Women in Tertiary Care Center in Eastern Nepal

Background Hirsutism is excess terminal hair growth in women at androgen-dependent sites of the body and it has great impact on psychological and social aspects of their lives, thus affecting their quality of life (QoL). Several studies assessing the quality of life in hirsute women could be found in world literature but none in Nepalese literature. So, this study was undertaken for the assessment of the impact of hirsutism on the quality of life in Nepalese women.&#x0D; Objective To assess the effect of hirsutism on quality of life of women in a tertiary center of Eastern Nepal and its association with various socio-demographic and clinical parameters.&#x0D; Method A cross-sectional questionnaire-based study was conducted in 49 participants aged 10 to 49 years at the Department of Dermatology, B.P. Koirala Institute of Health Sciences. Clinically diagnosed hirsute females with modified Ferriman-Gallwey (mFG) score &gt; 8, were enrolled and asked to fill Dermatology Life Quality Index (DLQI) questionnaire in the Nepalese version.&#x0D; Result More than 57.2% of the study population was of age 20 to 29 years with a mean of 27.76±8.08 years. The mean Dermatology Life Quality Index score was 7.78±4.95. The moderate effect was seen in the majority of participants (36.7%) with a predominant effect upon aspects of life like daily activities and symptoms and feelings. Participants with higher mF-G score (22.15±3.82) had a very large effect on their quality of life. Younger unmarried women with a school education and having a longer duration of hirsutism were found to have a higher effect upon their quality of life. However, the association was not statistically significant.&#x0D; Conclusion Hirsutism had affected the quality of life moderately with predominant effect upon aspects like daily activities and symptoms and feelings. No significant association was elicited between severity of hirsutism and its effect on quality of life from our study.

Serum GDF9 and BMP15 as Markers of Ovarian Function in Healthy Women and Women with Polycystic Ovary Syndrome

Background: The oocyte-secreted factors growth differentiation factor-9 (GDF9) and bone morphogenetic protein-15 (BMP15) are key regulators of female fertility and are predominantly expressed by oocytes. Recently, methods to quantitate these proteins in serum have demonstrated diagnostic potential. It is unknown if concentrations reflect ovarian and endocrine function, particularly in women with polycystic ovary syndrome (PCOS), where GDF9/BMP15 function is suggested to be aberrant. Aim: To determine if serum GDF9/BMP15 are associated with ovarian and endocrine parameters, and the ovarian pathologies, PCOM and PCOS. Method: Women aged 21-45 years (n=381) were from a cross-sectional study at the National University Hospital, Singapore, including healthy volunteers and referrals from gynecological clinics. Transvaginal ultrasound scans, blood tests and questionnaire were performed. Serum GDF9 and BMP15 were assessed relative to ovarian (cycle regularity, ovarian volume, AFC, AMH) and androgenic (testosterone, DHT, androstenedione, DHEAS, SHBG, mFG score) characteristics. PCOM and PCOS were determined using the Rotterdam criteria. Statistical analyses used parametric survival models and Kendall’s tau correlation appropriate for data containing values below the limit of detection. Results: Serum GDF9 and BMP15 were detectable in 40% and 41% of women, respectively. Serum GDF9 positively correlated with ovarian volume (p=0.02), AFC (p=0.004), and weakly with AMH (p=0.05). Furthermore, irregular menstrual cycles were associated with high GDF9 (p=0.005), and similar, although non-significant associations were seen for BMP15. When stratified into PCOS (n=130), PCOM (n=59), and control (n=192), GDF9 and BMP15 concentrations were not significantly different, and were not associated with the majority of androgenic features of PCOS. However, the relationship between GDF9 and AFC was significantly different between PCOM, PCOS and control women (p=0.02). Conclusion: These results suggest that serum GDF9 and BMP15 reflect ovarian characteristics but not androgenic characteristics of PCOS, and that the relationships between GDF9 and AFC may be aberrant in women with PCOM/PCOS.

Hirsutism, Normal Androgens and Diagnosis of PCOS.

Hirsutism is defined as the presence of terminal hair with male pattern distribution in women. While in the general population, hirsutism affects around 4–11% of women, it is the main manifestation of hyperandrogenism in women with polycystic ovary syndrome (PCOS), with a prevalence estimated at 65–75%. Hirsutism in PCOS is associated with both androgen excess and individual response of the pilosebaceous unit to androgens. The modified Ferriman–Gallwey (mFG) scoring system has been widely used in clinical practice to visually score excessive terminal hair, thus standardizing hirsutism evaluation and facilitating data comparison. Although a universal mFG score cutoff would be useful for comparisons, ethnic variations, as well as skin type and other factors, should be considered when evaluating hirsutism in distinct populations. In turn, androgen levels, measured by conventional techniques, have been shown to correlate poorly with the severity of hirsutism. Indeed, while most women with PCOS and hirsutism also have higher than reference values for serum androgen levels, some of them may not present with biochemical hyperandrogenism, representing a challenge to the diagnosis of PCOS. In this article, we critically review this not uncommon condition in women with PCOS presenting with hirsutism but normal androgen levels.

Correlating Physician versus Adolescent Self-Rating Using Modified Ferriman-Gallwey (mFG) Hirsutism Scoring to Androgen Levels

Background: Hirsutism affects 5-15% of reproductive-age women and is characterized by excessive terminal hair growth in a male pattern distribution. The gold standard screening tool for quantifying hirsutism is the mFG score. In the absence of specific hormonal markers and preexisting depilation confounding the physical exam for hirsutism, we are the first to study if adolescent vs physician rated hirsutism using mFG correlates to androgen levels.

Effect of calcium and vitamin D supplementation on the clinical, hormonal, and metabolic profile in non-obese women with polycystic ovary syndrome

In this study, we investigated the effect of calcium and vitamin D (Ca/Vit D) supplementation on the clinical, hormonal, and metabolic profile of patients with low vitamin D levels. In addition, we investigated the effect of Ca/Vit D supplementation on asymmetric dimethylarginine (ADMA) level in patients with polycystic ovary syndrome (PCOS). In total, 75 patients aged 19-35years, with a normal body mass index and a diagnosis of PCOS and Vit D deficiency/insufficiency, were included in the study. Patients received 50,000IU of vitamin D3 once a week for 8weeks. Afterward, 2500mg calcium carbonate equivalent to 1000mg calcium ion and 9.68mg cholecalciferol equivalent to 880IU vitamin D3 were administered orally as a maintenance treatment once a day. The mean age of the patients was 21.7 ± 3.5. After Ca/Vit D supplementation, Vit D levels significantly increased compared to baseline (8.6ng/ml) levels. An increase in SHBG levels (p < 0.001), a decrease in total testosterone, FAI (p = 0.042), and ADMA levels (p < 0.001) were observed in the first and third months compared to the onset. Significant improvement compared to baseline was observed in menstrual irregularity and median mFG score. Ca/Vit D supplementation can improve PCOS symptoms such as menstrual dysfunction, hirsutism, and hyperandrogenism. It may be effective in reducing the risk of cardiovascular disease in patients with PCOS later in life by decreasing ADMA levels, which is an indicator of endothelial dysfunction.