What is the management approach for a patient with elevated Dehydroepiandrosterone sulfate (DHEA-S) levels without other abnormal laboratory findings?

From the Guidelines

The management of isolated elevated DHEA-S levels without other laboratory abnormalities typically involves monitoring rather than immediate intervention. Patients should undergo periodic reassessment with repeat DHEA-S measurements every 6-12 months to track any changes. If the elevation is mild to moderate and the patient is asymptomatic, watchful waiting is appropriate as isolated DHEA-S elevations often don't require specific treatment 1. For patients concerned about potential underlying causes, a comprehensive history and physical examination should be performed to rule out conditions like polycystic ovary syndrome in women or adrenal disorders. Lifestyle modifications including regular exercise, stress management techniques, and maintaining a healthy weight may help normalize adrenal hormone production.

Key Considerations

• Isolated DHEA-S elevations are relatively common and often do not indicate serious pathology requiring immediate intervention 1
• The decision to intervene should be based on the presence of symptoms or significant changes in DHEA-S levels over time
• Referral to an endocrinologist is warranted if symptoms develop or levels continue to rise significantly on follow-up testing for further evaluation, which might include adrenal imaging studies to rule out adrenal tumors 1
• The use of DHEA replacement therapy may be considered in patients with primary adrenal insufficiency, but its long-term effects are not well established and it should be used with caution 1

Monitoring and Follow-up

• Patients with isolated elevated DHEA-S levels should undergo periodic reassessment with repeat DHEA-S measurements every 6-12 months
• Lifestyle modifications and monitoring for symptoms or changes in DHEA-S levels are key components of management
• Further evaluation, including adrenal imaging studies, may be necessary if symptoms develop or DHEA-S levels continue to rise significantly over time 1

From the Research

Management Approach for Elevated DHEA-S Levels

Elevated Dehydroepiandrosterone sulfate (DHEA-S) levels without other abnormal laboratory findings can be managed through a step-by-step approach:

• Investigation of Hyperandrogenism: According to 2, the first step is to investigate hyperandrogenism, which may involve measuring total testosterone levels.
• DHEA-S Assay: If testosterone levels are twice the upper limit of normal, a DHEA-S assay should be performed to determine the origin of the androgen excess 2.
• Adrenal Cortical Adenoma: A DHEA-S level over 600 mg/dl may indicate an androgen-secreting adrenal cortical adenoma 2.
• Other Causes: Other causes of elevated DHEA-S levels, such as non-classical congenital adrenal hyperplasia or adrenal tumors, should be considered and excluded through further testing and evaluation 3, 4, 5.

Diagnostic Considerations

When evaluating a patient with elevated DHEA-S levels, the following diagnostic considerations should be taken into account:

• Clinical Evaluation: A careful patient history and physical examination are essential in evaluating patients with acne or alopecia 3.
• Laboratory Tests: Laboratory tests, such as measurement of 17OH-progesterone levels or a dexamethasone suppression test, may be necessary to exclude other causes of hyperandrogenism 5.
• Imaging Studies: Imaging studies, such as transvaginal sonography or adrenal computed tomography scan, may be necessary to evaluate for ovarian or adrenal tumors 6.

Predictive Value of Testosterone and DHEA-S Levels

The predictive value of testosterone and DHEA-S levels for androgen-secreting neoplasms is limited:

• Low Frequency of Disorder: The low frequency of androgen-secreting neoplasms makes the measurement of testosterone and DHEA-S levels a less effective screening method 6.
• Clinical Evaluation: Clinical evaluation alone is often sufficient for screening, and further testing should be guided by clinical suspicion and laboratory results 6.