Is a Dehydroepiandrosterone sulfate (DHEAS) level of 109 within the normal range?

Is a DHEAS Level of 109 Normal?

A DHEAS level of 109 µg/dL (or approximately 2.9 µmol/L) is generally within the normal range for most adult populations, though interpretation requires consideration of the patient's age, sex, and specific laboratory reference ranges, as DHEAS declines significantly with advancing age. 1, 2

Context-Dependent Interpretation

The normality of this value depends critically on several factors:

Age and Sex Considerations

• DHEAS levels are highly age-dependent, with peak values occurring in the third decade of life and progressive decline thereafter, making age-adjusted reference ranges essential for accurate interpretation 1
• For women aged 20-29 years, elevated DHEAS is typically defined as >3800 ng/mL (>380 µg/dL or >10.3 µmol/L), while for ages 30-39, the threshold is >2700 ng/mL (>270 µg/dL or >7.3 µmol/L) 2
• A value of 109 µg/dL falls well below these thresholds for pathologic elevation in reproductive-age women 2

Clinical Significance of This Level

• In the context of hyperandrogenism evaluation, DHEAS >600 µg/dL (>16.3 µmol/L) suggests androgen-secreting adrenal cortical adenoma, making your value of 109 µg/dL reassuringly low and not suggestive of adrenal pathology 3
• Research demonstrates that DHEAS levels >6000 ng/mL (>600 µg/dL) are the threshold used to screen for adrenocortical tumors, with a specificity of 98% 4
• Values in the normal range like 109 µg/dL effectively exclude adrenal androgen-secreting neoplasms 4

Diagnostic Performance in PCOS

• When evaluating for polycystic ovary syndrome (PCOS), DHEAS measurement shows a pooled sensitivity of 0.75 and specificity of 0.67 across multiple studies, with an area under the curve of 0.77 5
• DHEAS is less diagnostically accurate than total testosterone, calculated free testosterone, or free androgen index for identifying PCOS, making it a secondary rather than primary marker 5
• The relatively modest diagnostic performance means that normal DHEAS levels do not exclude PCOS if other clinical and biochemical features are present 5

When Normal DHEAS Requires Further Evaluation

Despite being numerically normal, this value should prompt additional assessment if:

• Clinical signs of hyperandrogenism are present (hirsutism, acne, androgenetic alopecia, menstrual irregularities), as normal DHEAS does not exclude ovarian sources of androgen excess 1, 2, 3
• The patient has oligomenorrhea or other features suggesting PCOS, which primarily involves ovarian rather than adrenal androgen production 2
• Total testosterone is elevated (>8.7 nmol/L or >250 ng/dL), which would suggest ovarian hyperthecosis or ovarian tumor rather than adrenal pathology 3, 4

Recommended Complementary Testing

• Measure total testosterone, free testosterone, and sex hormone-binding globulin (SHBG) to calculate free androgen index, as these have superior diagnostic accuracy for hyperandrogenism 5, 2
• Assess LH, FSH, and consider pelvic ultrasound if PCOS is suspected clinically 2
• If testosterone is twice the upper limit of normal, DHEAS measurement helps localize the source (adrenal vs. ovarian), but your normal DHEAS points away from adrenal origin 3

Clinical Pitfalls to Avoid

• Do not rely solely on DHEAS to exclude hyperandrogenism, as it has lower sensitivity and specificity compared to testosterone measurements 5
• Remember that DHEAS levels can be falsely reassuring in patients with predominantly ovarian androgen excess 3
• Always interpret DHEAS in conjunction with clinical presentation rather than as an isolated laboratory value 1, 2
• In elderly patients, even "normal" DHEAS levels may be relatively elevated for age, requiring age-specific reference ranges 1