What are significant Dehydroepiandrosterone sulfate (DHEAS) levels?

Significant DHEAS Levels: Age-Specific Reference Ranges and Clinical Implications

Significant DHEAS (dehydroepiandrosterone sulfate) levels are defined by age-specific reference ranges, with values exceeding 3800 ng/ml for ages 20-29 and 2700 ng/ml for ages 30-39 warranting further investigation for possible adrenal disorders. 1

Age-Specific Reference Ranges

DHEAS is an androgen primarily produced by the adrenal glands. Its levels vary significantly by age and sex:

• Ages 20-29: Values >3800 ng/ml are considered elevated 1
• Ages 30-39: Values >2700 ng/ml are considered elevated 1
• Normal aging: DHEAS levels peak between ages 20-30 and gradually decline thereafter 2

Clinical Significance of Abnormal DHEAS Levels

Elevated DHEAS Levels

Elevated DHEAS levels may indicate:

1. Adrenal disorders:

   • Congenital adrenal hyperplasia (non-classical form) 1
   • Adrenocortical carcinoma (though levels can be variable) 1, 3
   • Adrenal adenomas (though most commonly associated with low DHEAS) 1

2. Polycystic Ovary Syndrome (PCOS):

   • High DHEAS occurs in approximately 20-33% of PCOS patients 1
   • More common in younger patients and varies by ethnicity (33% in Black vs. 20% in White patients) 1

3. Very high levels (>600 mg/dl):

   • Strongly suggestive of androgen-secreting adrenal cortical adenoma 4
   • Requires immediate evaluation to rule out malignancy

Low DHEAS Levels

Low DHEAS levels may indicate:

1. Adrenal insufficiency or adrenal suppression 2
2. Functional adrenal adenomas (cortisol-producing, aldosterone-producing, and even non-hyperfunctioning adenomas) 3
3. Chronic illness including advanced malignancy 5
4. Chronic narcotic use 2

Diagnostic Algorithm for Abnormal DHEAS

When encountering abnormal DHEAS levels:

1. For elevated DHEAS:

   • Confirm elevation with repeat testing
   • Perform additional androgen testing (testosterone, androstenedione) 1
   • Consider adrenal imaging if DHEAS >600 mg/dl or twice upper limit of normal 4
   • Consider dexamethasone suppression test to differentiate adrenal vs. ovarian source 6

2. For low DHEAS:

   • Consider adrenal insufficiency evaluation (ACTH stimulation test) 2
   • Evaluate for functional adrenal adenomas with additional hormonal testing 3
   • Consider chronic illness or medication effects 2, 5

Important Clinical Considerations

• Assay variability: DHEAS measurements can vary significantly between laboratories and assay methods 1
• Predictive value limitations: In non-selected patients with incidentally detected adrenal tumors, low DHEAS alone has poor predictive value for hormonal activity (sensitivity 0.60, specificity 0.75) 5
• Transporter abnormalities: Rare cases of very high DHEAS can occur due to transporter protein defects rather than tumors 7
• Post-surgical monitoring: After adrenal surgery, DHEAS levels may remain suppressed for years, especially after cortisol-producing adenoma removal 3

When to Refer for Specialist Evaluation

• DHEAS levels >2× upper limit of normal
• DHEAS levels >600 mg/dl
• Rapidly changing DHEAS levels
• DHEAS abnormalities with clinical signs of virilization 1
• Adrenal incidentalomas with abnormal DHEAS levels 1

DHEAS interpretation should always be done in the clinical context, considering age, sex, comorbidities, and other hormonal parameters to guide appropriate management decisions.