From the Guidelines
DHEAS testing is primarily indicated for evaluating signs of androgen excess in women and children, particularly when investigating hirsutism, virilization, precocious puberty, or menstrual irregularities, and should be ordered when clinical presentation suggests possible adrenal disorders such as congenital adrenal hyperplasia, adrenal tumors, or polycystic ovary syndrome, as recommended by the 2023 International PCOS Guidelines 1. The test is most valuable when combined with other hormone measurements like testosterone, androstenedione, and 17-hydroxyprogesterone to provide a comprehensive picture of androgen metabolism. Some key points to consider when ordering DHEAS testing include:
- Clinical presentation: DHEAS testing should be ordered when clinical presentation suggests possible adrenal disorders, such as congenital adrenal hyperplasia, adrenal tumors, or polycystic ovary syndrome.
- Age and sex: DHEAS levels naturally decline with age, so interpretation must consider the patient's age and sex.
- Combination with other tests: DHEAS testing is most valuable when combined with other hormone measurements like testosterone, androstenedione, and 17-hydroxyprogesterone.
- Diurnal pattern: Morning collection is preferred as DHEAS follows a diurnal pattern, though less pronounced than cortisol. According to the 2023 International PCOS Guidelines, DHEAS may be considered as a second-line diagnostic androgen marker for PCOS, but its use is limited by poorer specificity compared to other markers like TT, cFT, or FAI 1. In adult women, DHEAS measurement helps differentiate between adrenal and ovarian sources of excess androgens, as DHEAS is predominantly produced by the adrenal glands 1. For children with early development of secondary sexual characteristics, DHEAS testing can identify premature adrenarche 1. The test may also be useful in evaluating certain cases of infertility or in monitoring patients with known adrenal disorders 1.
From the Research
Indications for Ordering DHEAS
The following are indications for ordering DHEAS:
- Hyperandrogenism, as DHEAS levels are often elevated in patients with hyperandrogenism 2
- Hirsutism, as DHEAS levels are correlated with hirsutism score 2
- Adrenal insufficiency, as DHEAS levels can help diagnose adrenal insufficiency 3, 4, 5
- Polycystic ovary syndrome (PCOS), as DHEAS levels can be elevated in patients with PCOS 2, 6
- Cushing's disease, as DHEAS levels can be affected in patients with Cushing's disease 6
- Late-onset adrenogenital syndrome, as DHEAS levels can be elevated in patients with this condition 6
Clinical Scenarios
In the following clinical scenarios, ordering DHEAS may be considered:
- Patients with symptoms of hyperandrogenism, such as hirsutism, acne, or alopecia 2, 6
- Patients with suspected adrenal insufficiency, particularly if baseline cortisol levels are low or equivocal 3, 4, 5
- Patients with PCOS or other disorders of androgen excess 2, 6
- Patients with Cushing's disease or other disorders of cortisol excess 6
- Patients with late-onset adrenogenital syndrome or other disorders of adrenal steroidogenesis 6
Laboratory Tests
The following laboratory tests may be ordered in conjunction with DHEAS: