Normative cut-offs for polycystic ovary syndrome diagnostic features in adolescents using cluster analysis

Author:

Kiconco Sylvia1ORCID,Earnest Arul2,Enticott Joanne1,Hart Roger3ORCID,Mori Trevor A4,Hickey Martha5ORCID,Teede Helena J16,Joham Anju E16

Affiliation:

1. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University , Clayton, VIC 3800 , Australia

2. Department of Epidemiology and Preventative Medicine, Monash University , Melbourne, VIC 3004 , Australia

3. Division of Obstetrics and Gynaecology, Medical School, University of Western Australia , Perth, WA 6008 , Australia

4. Discipline of Internal Medicine, Medical School, University of Western Australia , Perth, WA 6000 , Australia

5. Department of Obstetrics and Gynaecology, The University of Melbourne and the Women's Hospital , Parkville, VIC 3052 , Australia

6. Department of Endocrinology and Diabetes, Monash Health , Clayton, VIC 3004 , Australia

Abstract

Abstract Objective The diagnosis of polycystic ovary syndrome (PCOS) remains challenging with international guidelines prioritising accurate cut-offs for individual diagnostic features. These diagnostic cut-offs are currently based on arbitrary percentiles, often from poorly characterised cohorts, and are dependent on variable laboratory ranges defined by assay manufacturers, limiting diagnostic accuracy. Cluster analysis is the recommended approach for defining normative cut-offs within populations for clinical syndromes. Few PCOS adult studies have applied cluster analysis, with no studies in adolescents. We aimed to define normative cut-offs for individual PCOS diagnostic features in a community-based population of adolescents using cluster analysis. Design This analysis utilised data from the Menstruation in Teenagers Study, a subgroup of the Raine Study, which is a population based prospective cohort of 244 adolescents whose mean age at PCOS assessment was 15.2 years. Methods K-means cluster analysis and receiver operating characteristics curves were used to define normative cut-offs for modified Ferriman–Gallwey (mFG) score, free testosterone (free T), free androgen index (FAI), and menstrual cycle length. Results Normative cut-offs for mFG, free T, FAI, and menstrual cycle lengths were 1.0, 23.4 pmol/L, 3.6, and 29 days, respectively. These corresponded to the 65th, 71st, 70th, and 59th population percentiles, respectively. Conclusion In this novel study, we define the normative diagnostic criteria cut-offs in this unselected adolescent population and show that these cut-offs correspond to lower percentiles than conventional cut-offs. These findings highlight the pertinent need to re-define PCOS diagnostic cut-offs in adolescents. Validation is required in larger, multi-ethnic, and well-characterised adolescent cohorts.

Funder

NHMRC Centre for Research Excellence for Women's Health and Reproductive Life grant

CRE WHIRL

Research Training Program Scholarship

Commonwealth of Australia

NHMRC Leadership Fellowships

NHMRC CRE WHiRL Fellowship

NHMRC Fellowship

Publisher

Oxford University Press (OUP)

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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