From the Guidelines
For a patient with elevated DHEA-S levels, I recommend drawing several key labs to determine the underlying cause, including total and free testosterone, androstenedione, 17-hydroxyprogesterone, cortisol (morning), ACTH, LH, FSH, estradiol, and prolactin, as well as thyroid function tests (TSH, free T4), as suggested by the most recent study 1 and 1. These tests are essential because elevated DHEA-S, an adrenal androgen precursor, can result from various conditions including polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia, adrenal tumors, Cushing's syndrome, or certain medications. The pattern of hormone abnormalities helps distinguish between these causes - for example, elevated 17-hydroxyprogesterone suggests congenital adrenal hyperplasia, while elevated testosterone and LH:FSH ratio points toward PCOS. Proper diagnosis is crucial as treatment approaches differ significantly depending on the underlying cause. Additionally, if adrenal or ovarian tumors are suspected, imaging studies such as adrenal CT scan or pelvic/transvaginal ultrasound should be considered, as recommended by 1 and 1. For suspected congenital adrenal hyperplasia, an ACTH stimulation test may be necessary, as mentioned in 1. It is also important to note that the diagnostic accuracy of androgen measurement in PCOS has been evaluated in recent studies 1, 1, and 1, which informed the 2023 International PCOS Guidelines, recommending the use of TT, FT, and FAI as first-line laboratory tests to assess biochemical hyperandrogenism in the diagnosis of PCOS. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) is recommended for androgen measurement due to its high accuracy, as stated in 1. In summary, a comprehensive hormonal panel, thyroid function tests, and imaging studies, as needed, are crucial for determining the underlying cause of elevated DHEA-S levels and guiding appropriate treatment.
From the Research
Labs to Draw with High DHEA-S
To investigate the cause of elevated Dehydroepiandrosterone sulfate (DHEA-S) levels, several labs can be drawn, including:
- Testosterone (T) and androstenedione (A) levels, as high DHEA-S is often associated with higher values of these hormones 2
- 17-Hydroxyprogesterone (OHPG), 11-deoxycortisol, and cortisol levels to rule out congenital adrenal hyperplasia (CAH) 3
- Insulin and glucose levels, as obesity and insulin resistance can contribute to increased androgen production 4
- Lipid profile and cardiovascular risk factors, as low DHEA-S levels have been correlated with increased cardiovascular disease and all-cause mortality 5
Additional Considerations
When interpreting lab results, it's essential to consider the patient's age, as DHEA-S levels decline with age 2. Additionally, the patient's phenotype, such as polycystic ovary syndrome (PCOS), can influence the results, as some studies suggest that adrenal hyperandrogenism is more common in non-classic PCOS phenotypes 2, 4.
Laboratory Tests
The following laboratory tests can be used to quantify DHEA, DHEA-S, and other related hormones: