Clitoromegaly is not uncommon in polycystic ovary syndrome and is associated with hyperandrogenism

Presenting author: Dr. Hafsa Mahrukh, Resident, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

*Correspondence: Dr. Hurjahan Banu, Department of Endocrinology, BSMMU. Cell: +8801712-614949, E-mail: dr.hurjahan_banu@yahoo.com.

ABSTRACT

Background: Clitoromegaly is a feature of virilization. Polycystic ovary syndrome (PCOS) is a condition with mild hyperandrogenism. The literature does not adequately describe the association of clitoromegaly in patients with PCOS.

Objectives: To see the association of clitoromegaly with PCOS and its features.

Methods: This cross-sectional study was conducted in the Department of Endocrinology, BSMMU during the year 2022. A total of 98 patients with PCOS were enrolled on the basis of revised 2003 Rotterdam criteria. Clinical features were documented after taking informed consent, including clitoral length and breadth. Blood was drawn in a fasting state to measure TSH, prolactin, total testosterone, sex-hormone binding globulin, 17-hydroxy progesterone (17OHP), luteinizing hormone (LH), follicle-stimulating hormone, insulin, glucose, and lipid profile. Patients with basal 17OHP of 2-8 ng/mL were undergone 1-hour synacthen-stimulated 17OHP to exclude nonclassical congenital adrenal hyperplasia. A clitoral index of 35 mm² was considered clitoromegaly.

Results: Among 98 patients with PCOS, 14 had clitoromegaly. PCOS patients with clitoromegaly had significantly higher BMI, waist circumference, acanthosis, modified Ferriman-Gallwey (mFG) score, triglyceride, HOMA-IR, free androgen index (FAI), and basal 17-OH progesterone levels than those without clitoromegaly. However, percentages of irregular cycles and PCOM were statistically similar. Clitoral index significantly and positively correlated with mFG score, waist/hip ratio, FAI, DHEAS, LH, basal, and stimulated 17OHP. However, multivariate binary regression analysis showed, only the mFG score [OR= 1.2, p=0.041] and FAI [OR= 1.1, p=0.008] had predictive associations with clitoromegaly. ROC curve analysis revealed mFG score [AUC= 0.76] and FAI [AUC= 0.81] as moderate and fair markers of clitoromegaly respectively.

Conclusions: Clitoromegaly is present in a substantial proportion of patients with PCOS and associated with hyperandrogenism.

Keywords: Clitoromegaly, Polycystic ovary syndrome, Free androgen index, Modified Ferriman-Gallwey score