From the Research
Management of significantly elevated DHEA levels (>3000) requires a comprehensive approach focused on identifying and treating the underlying cause, with the most recent and highest quality study 1 suggesting that treatment depends on the etiology, and if an adrenal tumor is identified, surgical resection is typically recommended. The first step is to confirm the elevation with repeat testing and conduct a thorough diagnostic workup including adrenal imaging (CT or MRI) to rule out adrenal tumors, which are common causes of markedly elevated DHEA. For confirmed cases, treatment depends on the etiology, and according to 1, the treatment of adrenal hyperandrogenism is eminently surgical, in consideration of the frequent malignant origin. In cases of non-tumor causes like congenital adrenal hyperplasia (CAH), glucocorticoid therapy is the mainstay of treatment, often starting with hydrocortisone 15-20 mg/day in divided doses or prednisone 5-7.5 mg daily, as seen in 2. These medications suppress ACTH production, thereby reducing adrenal androgen synthesis. In cases of PCOS-related elevations, combined oral contraceptives containing ethinyl estradiol with anti-androgenic progestins like drospirenone can help normalize levels. Regular monitoring of DHEA levels every 3-6 months is essential to assess treatment efficacy. Additionally, addressing any clinical manifestations of hyperandrogenism (hirsutism, acne) may require adjunctive treatments such as spironolactone 50-200 mg daily or flutamide 250 mg twice daily. The goal of therapy is to normalize DHEA levels while minimizing side effects of treatment, as chronically elevated androgens can lead to metabolic complications and increased cardiovascular risk, as noted in 3 and 4. Some key points to consider in the management of elevated DHEA levels include:
- Identifying and treating the underlying cause
- Conducting a thorough diagnostic workup, including adrenal imaging
- Considering surgical resection for adrenal tumors
- Using glucocorticoid therapy for non-tumor causes like CAH
- Utilizing combined oral contraceptives for PCOS-related elevations
- Monitoring DHEA levels regularly to assess treatment efficacy
- Addressing clinical manifestations of hyperandrogenism with adjunctive treatments.