From the Guidelines
Elevated DHEA levels are most commonly caused by congenital adrenal hyperplasia (CAH), adrenal tumors, polycystic ovary syndrome (PCOS), Cushing's syndrome, and certain medications or supplements, as well as stress and insulin resistance, with the specific cause determining the appropriate treatment approach. When considering the causes of elevated DHEA levels, it's crucial to evaluate the patient's overall clinical presentation and medical history.
- Congenital adrenal hyperplasia (CAH), particularly the non-classical form, is a significant cause of elevated DHEA due to genetic enzyme deficiencies leading to overproduction of adrenal hormones 1.
- Adrenal tumors, including both benign adenomas and malignant carcinomas, can autonomously produce excess DHEA, highlighting the importance of imaging studies like CT or MRI for diagnosis 1.
- Polycystic ovary syndrome (PCOS) in women is frequently associated with elevated DHEA levels due to ovarian and adrenal hyperactivity, and its diagnosis involves criteria such as irregular menstrual cycles, hyperandrogenism, and polycystic ovaries on ultrasound 1.
- Cushing's syndrome, characterized by excess cortisol production, can also lead to increased DHEA levels, and its diagnosis involves tests like the dexamethasone suppression test and measurement of urinary free cortisol 1.
- Certain medications, particularly those containing DHEA supplements, can directly raise DHEA levels, and stress, both physical and psychological, stimulates the adrenal glands to produce more DHEA as part of the stress response.
- Insulin resistance can contribute to elevated DHEA through complex hormonal interactions, and certain rare genetic disorders affecting steroid metabolism may also cause high DHEA levels. Given the variety of potential causes, a comprehensive medical evaluation is essential to determine the underlying cause of elevated DHEA, as treatment approaches vary significantly depending on the diagnosis, ranging from medication adjustments to surgical intervention for tumors 1.
From the Research
Causes of Elevated DHEA Levels
Elevated Dehydroepiandrosterone (DHEA) levels can be caused by various factors, including:
- Premature adrenarche and congenital adrenal hyperplasia, as observed in a case study of a female adolescent with very high DHEAS levels 2
- Adrenal tumors, although a study found that very high DHEAS levels can also occur without a tumor 2
- A generalized exaggeration in adrenal steroidogenesis in response to ACTH stimulation, as seen in women with Polycystic Ovary Syndrome (PCOS) and excess adrenal precursor androgen production 3
- Inherited defects of enzymes responsible for steroid biosynthesis, although these account for only a small fraction of women with hyperandrogenism or APA excess 3
Associated Conditions
Elevated DHEA levels have been associated with various conditions, including:
- PCOS, where approximately 20-30% of women demonstrate excess adrenal precursor androgen production 3
- Cushing's disease, ectopic ACTH-producing tumor, and congenital adrenal hyperplasia, where plasma 16 beta-OH-DHEA levels are elevated 4
- Asymptomatic cortisol producing adrenal adenoma (ASCA), where serum DHEA-S levels are lower than those of healthy subjects but within the normal range 5
Hormonal Influences
Hormonal influences can also affect DHEA levels, including: