From the Guidelines
A DHEA serum test is crucial for diagnosing and managing adrenal gland disorders, particularly in patients with primary adrenal insufficiency (PAI), as it helps guide DHEA replacement therapy. The test measures the level of dehydroepiandrosterone (DHEA) in the blood, which is an important hormone produced by the adrenal glands 1. This hormone serves as a precursor to testosterone and estrogen, playing crucial roles in development, metabolism, and immune function.
Key Points to Consider
- The DHEA serum test is typically recommended when a doctor suspects adrenal gland disorders, such as primary adrenal insufficiency (PAI) 1.
- In patients with PAI, DHEA replacement therapy can be guided by serum DHEA sulphate (DHEAS), androstenedione, and testosterone levels, which should be maintained in the normal range when measured in the morning prior to DHEA ingestion 1.
- A pragmatic approach is to offer female patients with a persistent lack of libido and/or low energy levels despite optimized glucocorticoid and mineralocorticoid replacement a 6-month trial of DHEA replacement, which can be continued if clinically effective 1.
- The test requires a simple blood draw, usually performed in the morning when DHEA levels are highest, and no special preparation is typically needed, though your doctor may ask you to fast for 8-12 hours beforehand.
- Normal DHEA levels vary by age and sex, with levels naturally peaking in early adulthood and declining with age.
- Abnormally high levels may indicate adrenal tumors, congenital adrenal hyperplasia, or polycystic ovary syndrome (PCOS), while low levels could suggest adrenal insufficiency or Addison's disease.
Clinical Application
In clinical practice, DHEA replacement therapy should be used with caution due to the limited objective evidence of clinical benefit from large studies and the unknown long-term effects of DHEA or testosterone replacement therapy in patients with PAI 1. However, the potential benefits of DHEA replacement therapy in improving symptoms such as lack of libido and low energy levels in female patients with PAI make it a valuable treatment option.
From the Research
DHEA Serum Test
- The DHEA serum test is used to measure the levels of dehydroepiandrosterone (DHEA) in the blood, which can help diagnose adrenal insufficiency 2.
- Adrenal insufficiency is a condition where the adrenal glands do not produce enough hormones, including DHEA 3, 4.
- DHEA deficiency is associated with morbidity, including adverse impacts on metabolic function, quality of life, and sexuality in multiple studies 4, 5, 6.
Benefits of DHEA Replacement
- DHEA replacement has been shown to improve well-being, vitality, fatigue, and sexuality in women with adrenal insufficiency 3, 6.
- DHEA replacement also increases IGF-1 levels and restores low circulating androgens in women into the normal range 3, 6.
- However, the benefits of DHEA replacement are not universally agreed upon, and more research is needed to fully understand its role in the treatment of adrenal insufficiency 3, 4.
Diagnosis of Adrenal Insufficiency
- Baseline measurements of serum cortisol and DHEA-S levels can be helpful in diagnosing adrenal insufficiency, but a normal age- and sex-adjusted serum DHEA-S level can practically rule out the diagnosis 2.
- Dynamic biochemical studies, such as the 1-μg cosyntropin test, may be necessary to assess adrenal function in some patients 2.
- A random serum cortisol level of ≥ 12 μg/dL in the ambulatory setting or a normal age- and sex-adjusted DHEA-S level can make the diagnosis of adrenal insufficiency extremely unlikely 2.