SAT377 Revisiting The Utility Of Simplified Ferriman-Gallway Score (Sfg) To Predict Hirsutism In Brazilian Women
Authors: Oliveira Talita Fischer , Oliveira Talita Fernanda , da Penha Karine Lopes , Santana Dayane Campos , Lunardi Rocha Ana Luiza , Reis Fernando M , Premaor Melissa Orlandin , Candido Ana Lucia , Comim Fabio Vasconcellos 
Published: October 2023

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 &gt; 6 for South Americans [the criteria suggested by the Endocrine Society (ES)] or mFG &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&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 &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 &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