From the Guidelines
Elevated DHEAS levels should be managed by identifying the underlying cause, which may include adrenal hyperplasia, adrenal tumors, polycystic ovary syndrome (PCOS), or certain medications, and treated accordingly to alleviate symptoms and normalize androgen levels. The clinical implications of elevated DHEAS levels can vary depending on the underlying cause, but common symptoms include hirsutism, acne, and menstrual irregularities in women.
Causes and Evaluation
The evaluation of elevated DHEAS levels should include a thorough medical history, physical examination, and laboratory tests to determine the underlying cause.
- Adrenal hyperplasia and adrenal tumors can be evaluated using imaging studies such as CT or MRI scans.
- PCOS can be diagnosed based on clinical symptoms such as irregular menstrual cycles, hirsutism, and acne, as well as laboratory tests to rule out other causes of hyperandrogenism 1.
- Certain medications, such as anabolic steroids, can also cause elevated DHEAS levels.
Management Options
Management options for elevated DHEAS levels depend on the underlying cause and symptom severity.
- For mild elevations without symptoms, lifestyle modifications including weight loss, regular exercise, and a balanced diet may be sufficient.
- Pharmacological options include oral contraceptives (containing ethinyl estradiol 20-35 mcg with progestins like drospirenone or cyproterone acetate) for women with PCOS or hyperandrogenism symptoms.
- Anti-androgens such as spironolactone (50-200 mg daily), finasteride (5 mg daily), or flutamide (250 mg twice daily) may be used, though liver function should be monitored.
- Metformin (500-2000 mg daily) can help improve insulin sensitivity in PCOS patients.
- For adrenal tumors, surgical intervention may be necessary.
Monitoring and Follow-up
Regular monitoring of hormone levels, clinical symptoms, and potential side effects is essential during treatment.
- The goal is to normalize androgen levels and alleviate symptoms while addressing the underlying cause.
- Patients with elevated DHEAS levels should be educated on the importance of regular follow-up and monitoring to prevent long-term complications such as infertility, metabolic syndrome, and cardiovascular disease.
In terms of recent evidence, a study published in 2021 1 highlights the importance of early endocrinology consultation in patients with adrenal insufficiency, which can be associated with elevated DHEAS levels. However, the most relevant and recent study for the management of elevated DHEAS levels is not directly provided in the given evidence, but based on the available information, a comprehensive approach including lifestyle modifications, pharmacological interventions, and regular monitoring is recommended.
From the Research
Clinical Implications of Elevated DHEAS
Elevated Dehydroepiandrosterone sulfate (DHEAS) levels have been associated with various clinical conditions, including:
- Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency 2
- Polycystic ovary syndrome (PCOS) 3, 4
- Androgen-secreting neoplasms 5
Management Options
The management of elevated DHEAS levels depends on the underlying cause:
- In CAH, the goal is to suppress adrenal androgen production with glucocorticoid therapy 2, 6
- In PCOS, treatment may involve anti-androgen medications, hormonal contraceptives, or other therapies to regulate androgen production 3, 4
- In cases of suspected androgen-secreting neoplasms, further evaluation with imaging studies and surgical intervention may be necessary 5
Diagnostic Considerations
When evaluating elevated DHEAS levels, it is essential to consider the following:
- Age-related changes in DHEAS production 3
- Clinical presentation and hormonal patterns 4
- The use of DHEAS as a screening tool for androgen-secreting neoplasms has limited predictive value 5
- Combination of serum DHEA-S and 17-hydroxyprogesterone concentrations can be useful in assessing adequacy of control in CAH patients 6