From the Guidelines
Elevated DHEA levels can be caused by several conditions, including congenital adrenal hyperplasia (CAH), adrenal tumors, polycystic ovary syndrome (PCOS), Cushing's syndrome, and certain medications, with the most recent evidence suggesting that PCOS is a significant cause in women 1.
Causes of Elevated DHEA Levels
- Congenital adrenal hyperplasia (CAH): a genetic defect in enzymes needed for cortisol production, leading to excessive DHEA secretion
- Adrenal tumors: benign adenomas and malignant carcinomas can autonomously produce high amounts of DHEA
- Polycystic ovary syndrome (PCOS): a hormonal imbalance characterized by elevated DHEA, affecting approximately 4-6% of women in the general population 1
- Cushing's syndrome: excessive cortisol production can increase DHEA levels
- Medications: corticosteroids, certain antidepressants, and DHEA supplements can raise DHEA levels
- Stress: physical and psychological stress can stimulate adrenal hormone production, including DHEA
- Pituitary tumors: excess ACTH production can stimulate the adrenal glands to overproduce DHEA
Diagnosis and Testing
Proper diagnosis requires comprehensive testing, including:
- Blood tests: to measure DHEA, cortisol, and other hormone levels
- Imaging studies: to detect adrenal tumors or other abnormalities
- Genetic testing: to identify genetic defects associated with CAH or other conditions
- Physical examination: to look for signs of hormonal imbalances, such as hirsutism or virilization The most recent guideline for the prevention, detection, evaluation, and management of high blood pressure in adults also recommends testing for underlying causes of hypertension, including primary aldosteronism, obstructive sleep apnea, and pheochromocytoma/paraganglioma 1.
From the Research
Causes of Elevated DHEA Levels
Elevated Dehydroepiandrosterone (DHEA) levels can be caused by several factors, including:
- Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, where patients may have elevated DHEA levels if they are undertreated 2
- Adrenal tumors or hyperplasia, which can lead to an overproduction of DHEA
- Exogenous administration of DHEA, such as in replacement therapy or supplements 3, 4
- Certain medical conditions, such as polycystic ovary syndrome (PCOS) or adrenal insufficiency
Factors Affecting DHEA Levels
Several factors can affect DHEA levels, including:
- Age: DHEA levels decline with age, with a significant decrease after the age of 30 5
- Sex: Women have lower DHEA levels than men, and DHEA levels decrease more rapidly in women after menopause 5
- Treatment: Patients with CAH or adrenal insufficiency may have suppressed DHEA levels if they are overtreated, while undertreatment can lead to elevated DHEA levels 2, 6
Clinical Implications
Elevated DHEA levels can have various clinical implications, including:
- Increased androgenic activity, which can lead to symptoms such as acne, hirsutism, and male pattern baldness
- Increased risk of certain medical conditions, such as breast cancer or prostate cancer
- Effects on bone health, with DHEA supplementation potentially increasing bone mineral density 5
- Effects on muscle strength and body composition, with DHEA supplementation potentially improving muscle strength in men 3