From the Guidelines
Elevated DHEA-S levels are primarily associated with polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia, adrenal tumors, and Cushing's syndrome, which can lead to symptoms such as hirsutism, acne, irregular menstrual cycles, and infertility in women, and early puberty or feminization in men. The most recent and highest quality study, 1, recommends using testosterone (TT), free testosterone (FT), and free androgen index (FAI) as first-line laboratory tests to assess biochemical hyperandrogenism in the diagnosis of PCOS. If these tests are not elevated but clinical suspicion is high, measuring androstenedione (A4) and DHEA-S may be considered, noting their poorer specificity.
Some key points to consider in the evaluation of elevated DHEA-S levels include:
- The use of highly accurate liquid chromatography-tandem mass spectrometry (LC-MS/MS) for assessing biochemical hyperandrogenism for TT, DHEA-S, and A4, as recommended by 1.
- The importance of comprehensive evaluation, including additional hormone tests, imaging studies of the adrenal glands, and sometimes genetic testing, to determine the underlying cause of elevated DHEA-S levels.
- The potential for elevated DHEA-S levels to be associated with adrenal tumors, as discussed in 2, which may require surgical intervention.
- The need for proper diagnosis and treatment of underlying conditions, such as PCOS, congenital adrenal hyperplasia, and Cushing's syndrome, to prevent long-term complications and improve quality of life.
In terms of treatment, medications like spironolactone, oral contraceptives, or metformin may be prescribed for PCOS, while surgical intervention may be necessary for adrenal tumors. Congenital adrenal hyperplasia typically requires corticosteroid replacement therapy, such as hydrocortisone. Proper diagnosis and treatment can help alleviate symptoms and improve outcomes for individuals with elevated DHEA-S levels.
From the Research
Problems Associated with Elevated DHEA-S Levels
- Elevated DHEA-S levels have been linked to an increased risk of metabolic syndrome in elderly men 3
- High DHEA-S levels are associated with a higher risk of mortality from cancer, cardiovascular disease, and all causes in middle-aged and older men and women 4
- Elevated DHEA-S levels may be indicative of adrenal tumors, although very high levels can also be caused by other factors such as steroid sulfatase (STS) deficiency or defects in transporter proteins 5
- In postmenopausal women, low DHEA-S levels have been associated with increased cardiovascular disease risk and all-cause mortality, but the relationship between DHEA-S levels and mortality is complex and may be J-shaped 4, 6
- Elevated DHEA-S levels have also been linked to an increased risk of cardiovascular disease and all-cause mortality in certain populations 4, 7
Potential Health Risks
- Cardiovascular disease
- Cancer
- Metabolic syndrome
- Mortality from all causes
- Adrenal tumors or other endocrine disorders
Population-Specific Risks
- Elderly men: elevated DHEA-S levels are associated with an increased risk of metabolic syndrome 3
- Postmenopausal women: low DHEA-S levels are associated with increased cardiovascular disease risk and all-cause mortality, but the relationship between DHEA-S levels and mortality is complex 6
- Middle-aged and older men and women: high DHEA-S levels are associated with a higher risk of mortality from cancer, cardiovascular disease, and all causes 4