LBODP088 The Modified Ferriman-gallway Score Based On Obtained Pictures Is Comparable To In-person Evaluation: An Alternative Tool To Diagnose Hirsutism
Authors: Oliveira Talita Fernanda , Premaor Melissa Orlandin , Lunardi Ana Luiza , Siqueira Camila , Andrade Mariane , Reis Fernado , Candido Ana Lucia , Comim Fabio 
Published: November 2022

Abstract
Hirsutism is a common endocrine problem among women of reproductive age. Currently, the gold standard to establish the diagnosis of hirsutism is made through the modified Ferriman-Gallway score (mFG), which demands a trained and in-person evaluation. Other alternatives to determine the presence of hirsutism, such as self-reported questionnaires, have been proposed, but with a high rate of complaints of hair growth in non-hirsute women. Our study aimed to address if the use of images of the nine areas of mFG obtained by mobile phone could offer an alternative way to establish the diagnosis of hirsutism. This is a cross-sectional study approved by the local Ethics Committee (HC-UFMG/ Brazil). All patients from endocrine outpatient clinics were submitted to an initial evaluation of the mFG by two blind examiners, followed by the acquisition of images of the nine areas of mFG using a mobile (Samsung A51, 48 MP) under standard conditions. After being stored, the images of individual patients were submitted to the analysis of mFG for three independent blind examiners. We obtained information about the clinical diagnosis, medications, menses, history of alopecia or complaints about excessive hair growth, anthropometric data, and the recent history of hair removal or discoloration. A cuttoff of mFG of equal or superior to 4 was established as the criteria for hirsutism. Overall, 70 women were evaluated; 21.5% of the patients have a mFG superior or equal to 4. The mean age + SEM was 33.2 + 1.13 years, BMI 32.1 + 0.97 kg/m2. Most of these women (57.1%) have complain about excessive hair growth and 60% have abnormal menstrual cycles. In relation to ethnicity, 21% self-reported white, 32% black, and 47% other background. The (mean + SEM) of mFG was 3.32 + 0.44 ranging from 0 to 16; at the time of the evaluation, 22 patients (31%) had at least one area with a recent hair removal or discoloration. The evaluation of the three independent examiners identified a Fleiss’Kappa agreement of 81.4% with a Kappa index of 0.75 considered good for clinical evaluations. The Bland-Altman analysis used to compare in-person versus image-based approaches, showed a satisfactory concordance between the methods of 0.89 (95% CI from 0.83 to 0.92). The lower limit of agreement of mFG estimated was -2. 08 (95% CI -2.73 to -1.43) and the upper limit of agreement 4.14 (95% CI 3.491 to 4.79). To conclude, we observed an acceptable concordance between the mFG scores established in images obtained by mobiles (analyzed by clinicians) and those assessed in the presence of two trained examiners. Our results support the use of image acquisition of mFG areas as a valid approach for the diagnosis of hirsutism. More studies are necessary to make possible to use this resource in epidemiological studies or to improve the management of hirsute patients.
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