Differential Diagnosis for Elevated DHEAS (815)

Elevated Dehydroepiandrosterone sulfate (DHEAS) levels can be indicative of various conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Adrenal Hyperplasia: This condition, particularly congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, is a common cause of elevated DHEAS levels. The enzyme deficiency leads to an accumulation of precursors, including DHEAS.

• Other Likely Diagnoses

  • Adrenal Tumors: Both benign (adenomas) and malignant (carcinomas) tumors of the adrenal gland can produce androgens, including DHEAS, leading to elevated levels.
  • Cushing's Syndrome: Although more commonly associated with cortisol, some forms of Cushing's syndrome can also lead to increased production of other adrenal hormones, including DHEAS.
  • Polycystic Ovary Syndrome (PCOS): While not as high as in adrenal causes, some women with PCOS may have mildly elevated DHEAS levels due to ovarian stroma production of androgens.

• Do Not Miss Diagnoses

  • Adrenal Carcinoma: Although rare, adrenal carcinoma can cause significantly elevated DHEAS levels. Missing this diagnosis could be fatal due to the aggressive nature of the disease.
  • Pheochromocytoma with Androgen Excess: Rarely, pheochromocytomas can co-secrete androgens, including DHEAS. This diagnosis is critical due to the potential for severe hypertension and other complications.

• Rare Diagnoses

  • Familial Hyperandrogenism: Rare genetic conditions that lead to excessive androgen production, which can include elevated DHEAS.
  • Gonadal Tumors: Certain tumors of the ovaries or testes can produce androgens, potentially leading to elevated DHEAS levels, though this is less common than adrenal sources.
  • Exogenous Androgen Use: The use of anabolic steroids or other androgenic substances can lead to elevated DHEAS levels, though this would typically be identified through history and other laboratory findings.