From the Guidelines
Elevated dehydroepiandrosterone sulfate (DHEAS) levels are strongly indicative of an underlying adrenal disorder, such as congenital adrenal hyperplasia or adrenal tumors 1.
Implications of Elevated DHEAS Levels
The implications of elevated DHEAS levels include:
- Adrenal androgen excess: Elevated DHEAS levels can lead to an excess of adrenal androgens, which can cause symptoms such as hirsutism, acne, and male pattern baldness 1.
- Congenital adrenal hyperplasia: Elevated DHEAS levels can be a marker for congenital adrenal hyperplasia, a genetic disorder that affects the production of adrenal hormones 1.
- Adrenal tumors: Elevated DHEAS levels can also be a marker for adrenal tumors, such as adrenal adenomas or carcinomas 1.
Diagnostic Approach
In cases of elevated DHEAS, a diagnostic work-up should be initiated to determine the underlying cause, including:
- Hormonal evaluation: Measurement of serum DHEAS, androstenedione, and testosterone levels to assess adrenal androgen production 1.
- Imaging studies: Computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen to evaluate for adrenal tumors 1.
Treatment Approach
Treatment of elevated DHEAS levels depends on the underlying cause, but may include:
- Corticosteroids: Such as dexamethasone (0.5-1.0 mg orally daily) or prednisone (5-10 mg orally daily) to suppress adrenal androgen production 1.
- Medications to counteract excess androgens: Such as spironolactone (50-100 mg orally twice daily) or flutamide (125-250 mg orally twice daily) to manage symptoms of androgen excess 1.
- DHEA replacement therapy: In patients with primary adrenal insufficiency, DHEA replacement therapy may be considered to replace deficient adrenal androgen secretion 1. It is essential to monitor DHEAS levels and clinical symptoms regularly to guide therapy and adjust treatment as needed 1.
From the Research
Implications of Elevated DHEAS Levels
Elevated Dehydroepiandrosterone sulfate (DHEAS) levels have been associated with various conditions, including:
- Premature adrenarche and congenital adrenal hyperplasia 2
- Adrenal tumors, although very high DHEAS levels can also be found in individuals without tumors 2
- Androgenic disorders, such as hirsutism, acne, and androgenic alopecia 3, 4, 5
- Gynecologic endocrinopathy and infertility 4
Clinical Significance
The measurement of DHEAS levels can be a useful guide for adrenal androgen secretion 6. Elevated DHEAS levels can be suppressible with dexamethasone, which can be used to treat androgenic disorders 3, 4. However, the relationship between DHEAS levels and other hormonal responses is complex, and basal steroid levels may not be predictive of responses to ACTH stimulation 5.
Diagnostic and Therapeutic Considerations
- DHEAS levels can be used to differentiate between adrenal and ovarian sources of excess androgen production 5
- ACTH stimulation tests can reveal subtle defects in adrenal steroidogenesis, which may be indicative of late-onset congenital adrenal hyperplasia 5
- Dexamethasone suppression can be used to treat androgenic disorders, with effective suppression achieved at doses as low as 0.125 mg daily 3
- The combination of DHEAS measurement and clinical evaluation can add an important dimension to the study of gynecologic endocrinology and infertility 4