Management of Elevated DHEAS with Normal CBC
A DHEAS of 60 µg/dL in the context of normal CBC parameters does not require intervention and represents a normal physiologic level that needs no further workup or treatment. 1
Interpretation of Laboratory Values
DHEAS 60 µg/dL is within normal range for most adult populations and does not meet criteria for pathologic elevation requiring investigation 1, 2
The CBC parameters provided (HCT 44.5%, Hgb 15.0 g/dL, RDW 12.4%) are all normal and do not suggest any hematologic abnormality related to adrenal or endocrine dysfunction 1
Pathologic DHEAS elevation requiring workup begins at levels >700-800 µg/dL (approximately >16.3 µmol/L or 6000 ng/mL), which would raise concern for adrenal tumors or other androgen-secreting neoplasms 1, 3
When DHEAS Elevation Becomes Clinically Significant
DHEAS >700 µg/dL warrants adrenal imaging with CT scan to evaluate for adrenocortical tumors, hemorrhage, or other structural abnormalities 1, 3
In women with hyperandrogenic symptoms (hirsutism, virilization, acne), DHEAS >600 µg/dL combined with clinical findings may warrant further evaluation, though isolated DHEAS elevation without symptoms is often benign 4, 3
Total testosterone >250 ng/dL (8.7 nmol/L) has higher predictive value for androgen-secreting neoplasms than DHEAS elevation alone, with 100% sensitivity but only 9% positive predictive value 3
Clinical Context Matters
In suspected adrenal insufficiency, DHEAS levels are typically LOW, not elevated, often accompanied by low morning cortisol (<250 nmol/L or <9 µg/dL) and elevated ACTH 1, 5
The normal CBC differential rules out hematologic manifestations of severe endocrine disorders such as anemia from chronic disease or stress erythrocytosis 1
Age-adjusted reference ranges are critical for DHEAS interpretation, as levels decline progressively with age, and what appears elevated in an older adult may be normal for a younger person 1, 4
No Action Required for This Patient
No additional hormonal testing, imaging, or treatment is indicated based on DHEAS 60 µg/dL with normal CBC 2, 4
If clinical signs of hyperandrogenism, Cushing's syndrome, or adrenal insufficiency were present, those would drive further workup independent of this DHEAS level 1
Routine monitoring or repeat testing of DHEAS is not necessary in asymptomatic patients with normal baseline values 2, 4