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Dehydroepiandrosterone (DHEA) Sulfate 

  • Author: Georges Elhomsy, MD; Chief Editor: Eric B Staros, MD  more...
 
Updated: Dec 05, 2014
 

Reference Range

Serum dehydroepiandrosterone sulfate (DHEA-S) peaks around the third decade and then drop with age.

DHEA-S can be measured by radioimmunoassay, liquid chromatography-mass spectrometry, or chemiluminescent techniques, and the reference range varies with the technique used.

The reference range given below is for DHEA-S measured by chemiluminescent technique.

Table. Reference Range for DHEA-S, as Measured by Chemiluminescent Technique (Open Table in a new window)

 Male Female
Tanner stage  
Stage I< 15-120 mcg/dL16-96 mcg/dL
Stage II< 15-333 mcg/dL22-184 mcg/dL
Stage III< 15-312 mcg/dL< 15-296 mcg/dL
Stage IV29-412 mcg/dL17-343 mcg/dL
Stage V89-457 mcg/dL44-332 mcg/dL
Age  
18-29 years89-457 mcg/dL44-332 mcg/dL
30-39 years65-334 mcg/dL31-228 mcg/dL
40-49 years48-244 mcg/dL18-244 mcg/dL
50-59 years35-179 mcg/dL< 15-200 mcg/dL
≥ 60 years25-131 mcg/dL< 15-157 mcg/dL
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Interpretation

In clinical practice measurement of serum DHEA-S is preferred over serum DHEA, since DHEA-S has no circadian variation and longer half life.

Serum DHEA-S maybe increased in:

  • Polycystic ovary syndrome (PCOS)
  • Androgen-secreting adrenal carcinoma
  • Cushing's disease (elevated ACTH)[1]
  • Ectopic ACTH secreting tumor
  • Premature adrenarche[2]

Serum DHEA-S maybe decrease in

  • Cortisol secreting adrenal adenoma
  • Adrenal insufficiency

In Congenital adrenal hyperplasia (CAH), DHEA-S level varies with the type of the enzymatic deficiency:

  • High when due to 11-hydroxylase deficiency
  • 3-beta-hydroxysteroid dehydrogenase deficiency
  • 21-hydroxylase deficiency
  • Normal when due to: aldosterone synthase deficiency
  • Low when due to: cholesterol side-chain cleavage enzyme deficiency
  • 17-hydroxylase
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Collection and Panels

Patient instruction: No need for fasting

Collection tube: Red top tube

Unacceptable Conditions: Hemolyzed specimens

Specimen Preparation: Separate serum from cells and transfer to transport tube

Storage/Transport Temperature: Refrigerated

Stability: Refrigerated 7 days; frozen: 2 months.

Panels: None

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Background

Description

DHEA-S is a C-19 (19 carbon atoms) steroid hormones and 1 of 3 androgens (DHEA, DHEAS, androstenedione) secreted by the adrenal gland. It is a biologically inert hormone, produced from cholesterol in the zona reticularis with a daily rate of about 20 mg per day.[3, 4]

In the adrenal gland and the liver the DHEA is converted by DHEA sulfotransferase (SULT2A1) to dehydroepiandrosterone-sulfate (DHEA-S). DHEA-S possibly functions as a circulating storage pool for DHEA.

DHEA-S, under the effect of steroid sulfatase, is converted back to DHEA in the peripheral tissues, which in turn is converted to either more active androgens or estrogen.

Serum DHEA-S concentrations fall after birth then begins to increase around the age of 7-9 (adrenarche). It keeps increasing until the third decade. After that, it starts to drop, and, by the age of 80 years, the concentration is about 20% of that at age 25.

Indications/Applications

DHEA-S level is usually ordered with other hormones as part of the work up for the following:

Considerations

Abnormal DHEA-S is not considered diagnostic to any disease and should always be measured in conjunction with other hormones.

DHEA-S level can be decreased in anorexia nervosa and illness.

DHEA-S is increased with smoking.

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Contributor Information and Disclosures
Author

Georges Elhomsy, MD Fellow in Endocrinology, St Louis University School of Medicine

Georges Elhomsy, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Thyroid Association, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Eric B Staros, MD Associate Professor of Pathology, St Louis University School of Medicine; Director of Clinical Laboratories, Director of Cytopathology, Department of Pathology, St Louis University Hospital

Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology

Disclosure: Nothing to disclose.

References
  1. Yener S, Yilmaz H, Demir T, Secil M, Comlekci A. DHEAS for the prediction of subclinical Cushing's syndrome: perplexing or advantageous?. Endocrine. 2014 Aug 22. [Medline].

  2. Guran T, Firat I, Yildiz F, Bulut IK, Dogru M, Bereket A. Reference values for serum dehydroepiandrosterone sulfate in healthy children and adolescents with emphasis on the age of adrenarche and pubarche. Clin Endocrinol (Oxf). 2014 Sep 10. [Medline].

  3. Guber HA, Farag AF. Evaluation of endocrine function. McPherson: Henry's Clinical Diagnosis and Management by Laboratory Methods. 22 nd ed. Philadelphia, Pa. Saunders Company; 2011. chap 24.

  4. Bulum SE. Melmed: Williams Textbook of Endocrinology. Physiology and Pathology of the Female Reproductive Axis. 12th ed. Philadelphia, PA Saunders Company; 2011. chap 17.

  5. Cunningham SK, McKenna TJ. Dissociation of adrenal androgen and cortisol secretion in Cushing's syndrome. Clin Endocrinol (Oxf). 1994 Dec. 41(6):795-800. [Medline].

  6. Kroboth PD, Salek FS, Pittenger AL, Fabian TJ, Frye RF. DHEA and DHEA-S: a review. J Clin Pharmacol. 1999 Apr. 39(4):327-48. [Medline].

  7. Stewart PM, Krone NP. Melmed: Williams Textbook of Endocrinology. The Adrenal Cortex. 12th ed. Philadelphia, PA Saunders Company; 2011. chap 15.

  8. Thomas G, Frenoy N, Legrain S, Sebag-Lanoe R, Baulieu EE, Debuire B. Serum dehydroepiandrosterone sulfate levels as an individual marker. J Clin Endocrinol Metab. 1994 Nov. 79(5):1273-6. [Medline].

  9. Yamaji T, Ishibashi M, Takaku F, Itabashi A, Katayama S, Ishii J. Serum dehydroepiandrosterone sulfate concentrations in secondary adrenal insufficiency. J Clin Endocrinol Metab. 1987 Sep. 65(3):448-51. [Medline].

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Table. Reference Range for DHEA-S, as Measured by Chemiluminescent Technique
 Male Female
Tanner stage  
Stage I< 15-120 mcg/dL16-96 mcg/dL
Stage II< 15-333 mcg/dL22-184 mcg/dL
Stage III< 15-312 mcg/dL< 15-296 mcg/dL
Stage IV29-412 mcg/dL17-343 mcg/dL
Stage V89-457 mcg/dL44-332 mcg/dL
Age  
18-29 years89-457 mcg/dL44-332 mcg/dL
30-39 years65-334 mcg/dL31-228 mcg/dL
40-49 years48-244 mcg/dL18-244 mcg/dL
50-59 years35-179 mcg/dL< 15-200 mcg/dL
≥ 60 years25-131 mcg/dL< 15-157 mcg/dL
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