From the Guidelines
Elevated DHEA in females is most commonly caused by polycystic ovary syndrome (PCOS), with other potential causes including congenital adrenal hyperplasia, adrenal tumors, Cushing's syndrome, and certain medications like DHEA supplements. The symptoms of elevated DHEA can include irregular periods, acne, excessive hair growth (hirsutism), male-pattern baldness, and deepening voice. Diagnosis typically involves blood tests to measure hormone levels, including DHEA-sulfate (DHEA-S), and imaging studies like ultrasound or CT scans to examine the adrenal glands and ovaries 1.
Some key points to consider in the diagnosis and management of elevated DHEA include:
- PCOS is a common cause of irregular periods in women and is considered to affect approximately 4–6% of women in the general population 1.
- The pathogenesis of PCOS involves the acceleration of pulsatile gonadotropin releasing hormone (GnRH) secretion, insulin resistance, hyperinsulinaemia, and downstream metabolic dysregulation 1.
- Abnormalities of the reproductive axis are manifested as hypersecretion of luteinising hormone, ovarian theca stromal cell hyperactivity, and hypofunction of the follicle stimulating hormone (FSH)–granulosa cell axis resulting in hyperandrogenism, hirsutism, follicular arrest, and ovarian acyclicity 1.
- Treatment depends on the underlying cause but may include lifestyle modifications (weight loss, diet changes), oral contraceptives to regulate hormones, anti-androgen medications like spironolactone, and specific treatments for underlying conditions.
It's also important to note that DHEA is an androgen hormone produced primarily by the adrenal glands that serves as a precursor to testosterone and estrogen, which explains why elevated levels can cause androgenic (male hormone-like) symptoms in women. If you experience symptoms of high DHEA, consult with an endocrinologist or gynecologist for proper evaluation and personalized treatment. Additionally, vaginal DHEA can be considered for vaginal dryness or pain with sexual activity, but its use should be approached with caution in survivors receiving aromatase inhibitor therapy 1.
From the Research
Causes of Elevated DHEA in Females
The causes of elevated Dehydroepiandrosterone (DHEA) in females can be attributed to several factors, including:
- Polycystic Ovary Syndrome (PCOS): Approximately 20-30% of PCOS women demonstrate excess adrenal precursor androgen (APA) production, primarily using DHEAS as a marker of APA in general and more specifically DHEA synthesis 2.
- Adrenal hyperandrogenism: A subgroup of women with PCOS present an excessive adrenal androgen production, generally associated with ovarian hyperandrogenism 3.
- Inherited defects of the enzymes responsible for steroid biosynthesis: Although these defects account for only a very small fraction of women suffering from hyperandrogenism or APA excess 2.
- Generalized exaggeration in adrenal steroidogenesis: Women with PCOS and APA excess appear to have a generalized exaggeration in adrenal steroidogenesis in response to ACTH stimulation, although they do not have an overt hypothalamic-pituitary-adrenal axis dysfunction 2.
- Age: Adrenal androgens are strictly dependent on age and their blood values reduce by 40% in patients moving from their twenties to thirties 3.
Specific Conditions Associated with Elevated DHEA
Elevated DHEA levels have been observed in:
- Anovulatory women: Fifty percent of euprolactinemic anovulatory infertility patients exhibited increased adrenal androgen (AA) secretion, as evidenced by an elevated serum dehydroepiandrosterone sulfate (DHEA-S) level 4.
- PCOS women with non-classic (B or C) phenotypes: A lower prevalence of increased DHEAS in A phenotype PCOS patients, versus non-classic (B or C) PCOS phenotypes, was observed 3.
- Women with adrenal insufficiency: DHEA replacement may be beneficial in women with adrenal insufficiency, as it restores low circulating androgens and increases IGF-1 levels 5.