In a patient with elevated testosterone and other hormonal findings suggestive of polycystic ovary syndrome, does a mildly elevated DHEAS level exclude the diagnosis of PCOS?

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Last updated: November 4, 2026 • View editorial policy

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El DHEAS no elevado NO excluye el diagnóstico de SOP

Un nivel de DHEAS que no está muy elevado no descarta el diagnóstico de síndrome de ovario poliquístico cuando la testosterona y otras hormonas sugieren SOP. El DHEAS es un andrógeno de origen adrenal que tiene menor especificidad diagnóstica que la testosterona para SOP 1.

Por qué el DHEAS no es determinante

La guía internacional más reciente (2025) establece claramente que:

  • La testosterona total (TT) y la testosterona libre (FT) son las pruebas de primera línea para evaluar hiperandrogenismo bioquímico en SOP 1
  • El DHEAS tiene menor especificidad diagnóstica comparado con testosterona 1
  • El DHEAS solo debe considerarse cuando TT o FT no están elevadas 1

Criterios diagnósticos actuales

El diagnóstico de SOP se establece con 2 de 3 criterios (Rotterdam) 2:

  1. Hiperandrogenismo (clínico o bioquímico)
  2. Disfunción ovulatoria
  3. Morfología ovárica poliquística

Sobre el hiperandrogenismo bioquímico:

  • Testosterona elevada es suficiente para cumplir el criterio de hiperandrogenismo bioquímico
  • El DHEAS elevado se encuentra solo en 20-30% de mujeres con SOP 3
  • Aproximadamente 50% de mujeres con SOP tienen exceso de andrógenos adrenales (incluyendo DHEAS), pero esto no es requisito diagnóstico 4

Interpretación práctica

Si tu paciente tiene:

  • ✓ Testosterona elevada
  • ✓ Otras hormonas sugestivas de SOP
  • ✓ Cumple 2 de 3 criterios de Rotterdam

El diagnóstico de SOP es válido independientemente del nivel de DHEAS 1, 2.

Caveat importante:

El DHEAS debe medirse principalmente para excluir otras causas de hiperandrogenismo:

  • Tumores adrenales (DHEAS muy elevado >700 μg/dL)
  • Hiperplasia adrenal congénita no clásica (requiere medir 17-OHP) 2

Consideraciones adicionales

La evidencia muestra que:

  • El DHEAS elevado en SOP puede asociarse paradójicamente con mejor perfil metabólico (mejor perfil lipídico, menores marcadores inflamatorios) 5
  • La supresión con dexametasona de andrógenos adrenales (incluyendo DHEAS) no mejora consistentemente la ovulación en SOP, sugiriendo que los andrógenos adrenales juegan un papel limitado en la disfunción ovulatoria una vez establecido el síndrome 4
  • El índice de andrógenos libres (FAI) tiene la mayor precisión diagnóstica (sensibilidad 91.7%, especificidad 87.0%) 6

En resumen: procede con el diagnóstico de SOP basándote en testosterona elevada y cumplimiento de criterios de Rotterdam, sin que el DHEAS normal sea un obstáculo diagnóstico.

References

3
Research

DHEA, DHEAS and PCOS.

The Journal of steroid biochemistry and molecular biology, 2015

5
Research

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome.

Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 2012

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