Differential Diagnosis for High Level of DHEA and Increasing

Single Most Likely Diagnosis

• Adrenal Hyperplasia: This condition is characterized by the overproduction of androgens, including DHEA, due to an enzymatic deficiency in the adrenal gland. The increasing levels of DHEA are consistent with this diagnosis, as it often leads to an overproduction of androgens.

Other Likely Diagnoses

• Adrenal Tumor: Benign or malignant tumors of the adrenal gland can cause an increase in DHEA production. The tumor can autonomously produce androgens, leading to elevated DHEA levels.
• Congenital Adrenal Hyperplasia (CAH): Although typically diagnosed in infancy, some forms of CAH can present later in life with symptoms of androgen excess, including elevated DHEA levels.
• Polycystic Ovary Syndrome (PCOS): While not the primary cause, some women with PCOS may have elevated DHEA levels due to adrenal androgen production.

Do Not Miss Diagnoses

• Cushing's Syndrome: Although primarily associated with cortisol excess, some cases of Cushing's syndrome can also present with elevated androgen levels, including DHEA. Missing this diagnosis could lead to significant morbidity.
• Adrenal Carcinoma: A rare but aggressive tumor that can produce high levels of androgens, including DHEA. Early detection is crucial for treatment and prognosis.

Rare Diagnoses

• Familial Glucocorticoid Resistance: A rare genetic disorder that affects the body's response to cortisol, potentially leading to an increase in androgen production, including DHEA.
• DHEA-Producing Tumors in Other Locations: Rarely, tumors in other parts of the body, such as the ovary or testis, can produce DHEA, leading to elevated levels.