Assessment of hirsutism among Korean women: results of a randomly selected sample of women seeking pre-employment physical check-up

Jin Ju Kim 2 Soo Jin Chae 1 Young Min Choi 0 Seung Sik Hwang 5 Kyu Ri Hwang 4 Sun Mie Kim 2 Sang Ho Yoon 3 Shin Yong Moon 0 0 Department of Obstetrics and Gynecology, The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine , 28 Yungun-dong, Chongno-ku, Seoul 110-744, South Korea 1 Department of Obstetrics and Gynecology, Maria Fertility Hospital , Seoul, South Korea 2 Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital , Seoul, South Korea 3 Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital , Goyang, South Korea 4 Department of Obstetrics and Gynecology, Seoul Municipal Boramae Hospital , Seoul, South Korea 5 Department of Social and Preventive Medicine, College of Medicine, Inha University , Incheon, South Korea background: The objectives of this study were to define the distribution of the modified Ferriman - Gallwey (mF-G) score in a random group of Korean women and to study any association(s) between hirsutism and endocrine/metabolic markers. methods: A single investigator assessed the mF-G score prospectively in 1010 Korean women, who consulted a health-care center as part of a group check-up for employment. Logistic regression models were utilized to test the relationships between the presence of hirsutism and levels of endocrine/metabolic markers. results: Subjects had mF-G scores ranging from 0 to 19, and 505 subjects (50.0%) had an mF-G score of zero. Of the 1010 subjects, 95.1% had a score at or below six; thus, a score of six or greater represented hirsute women in our population. The most frequently affected site was the upper back, but the most densely affected area was found to be the lower abdomen. Hirsutism was significantly and positively associated with serum levels of total testosterone (T) and hemoglobin A1c, but negatively associated with those of sex hormone binding globulin (SHBG). In addition, the odds of a woman developing hirsutism were higher for increased total T and HbA1c, and lower for decreased SHBG. Hirsutism and homeostatic model assessment for insulin resistance were positively associated, but the relationship was not significant after adjusting for age and BMI. conclusions: mF-G scores greater that six represent the appropriate diagnostic cutoff for the detection of hirsutism in Korean women. Increased serum total T and HbA1c, and decreased SHBG concentrations were associated with the presence of hirsutism. Introduction Hirsutism is a disorder of excess growth of terminal hairs in androgendependent areas, which include the chin, upper lip, chest, breasts, abdomen, back and anterior thighs. Hirsutism is the most commonly used clinical indicator of hyperandrogenism. Although the causes of increased androgen production in women are diverse, polycystic ovary syndrome (PCOS) is regarded as the most common etiology of clinical hyperandrogenism in women (Azziz et al., 2004; Carmina et al., 2006). The first two authors contributed equally to this work. Excess body and facial terminal hair growth is measured semiquantitatively using a scoring system such as the mF-G score (Ferriman and Gallwey, 1961). Ferriman and Gallwey evaluated 9 hormonal sites in 161 women aged 18 38 and reported that a score above 5 was found in 9.9%, above 7 in 4.3% and scores above 10 in only 1.2% of women tested. Subsequently, Hatch et al. (1981) indicated that only 5% of premenopausal women had a score of eight or greater in the original data collected by Ferriman and Gallwey. Thus, they concluded that a score of eight or more represented hirsute women. Using this concept of the 95th percentile of the population, various values for defining hirsutism have been reported by different studies. Knochenhauer et al. (1998) reported that 7.6, 4.6 and 1.9% of women had an mF-G score of 6 or more, 8 or more and 10 or more, respectively, without differences between unselected black and white women; thus, the prevalence of hirsutism varied from 2 to 8% depending on the chosen cutoff F-G score. The PCOS/Troglitazone Study Group defined hirsutism as a score above six on the mF-G scale (Azziz et al., 2001); Chang et al. (2005) classified hirsutism as an mF-G score of seven or greater and DeUgarte et al. (2006) used a score of eight or greater. It is well known that there are racial variations in hair growth patterns (Bernstein and Rassman, 1997; Sperling, 1999; Lee et al., 2002). For example, Japanese women tend to have less body and facial hair than their non-Asian counterparts (Carmina et al., 1992), whereas European and Maori women are more likely than other ethnic groups to present with hirsutism (Williamson et al., 2001). The mF-G scoring system does not account for ethnic differences, and race-specific normative ranges have not been well established. Recently, DeUgarte et al. (2006) indicated that the prevalence and degree of facial and body terminal hair growth was similar in a randomly chosen group of black and white women. However, additional studies including other ethnic or racial groups, particularly Asians, have not yet been performed. The objectives of this study were to define the degree and distribution of the modified Ferriman Gallwey (mF-G) score in a random group of Korean women and study any association(s) between hirsutism and endocrine/metabolic markers. For these purposes, a single investigator obtained data prospectively in 1010 random Korean women who consulted a health-care center in our hospital as part of a group physical check-up for employment. Materials and Methods Subjects Between March 2005 and December 2008, 4550 premenopausal women, aged 18 40, visited a health-care center in Seoul National University Hospital as a part of group physical check-up for their occupation. The women underwent medical evaluations including a medical history, physical examination, blood sampling and radiologic imaging as part of a routine health check-up and cancer screening. Subjects completed a standardized history form related to physician-diagnosed diseases (such as gynecological, internal, mental, neurological and/or urological conditions), medication (any medication taking more than once a week), cigarette smoking, alcohol intake and socio-demographic factors (such as marital, educational and economic status). Of these women, 3048 received routine cancer screening and gynecologic examinations according to their health check programs, and were randomized to two gynecologists clinics. To eliminate inter-observer variations, the study subjects were examined by one gynecologic endocrinologist (J.J.K.) who also determined the hirsutism score. Among the 1448 women who received gynecologic examinations in the authors clinic, 438 women declined participation in the study, resulting in 1010 female enrollees. This project was approved by the review board for human research of Seoul National University Hospita (...truncated)