Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA) can be measured with radioimmunoassay, liquid chromatography–mass spectrometry (LC-MS), or chemiluminescent techniques, and the reference range varies by the technique used.

The reference ranges for DHEA concentrations measured with LC-MS are listed in Table 1.

Table 1. Reference Ranges of DHEA Concentrations by Tanner Stage, Age, and Sex as Measured With LC-MS (Open Table in a new window)

The image below depicts the molecular structure of DHEA.

Serum dehydroepiandrosterone (DHEA) concentrations peak around the third decade of life and then drop with age.

The serum DHEA level has a circadian variation and may vary during the menstrual cycle; therefore, dehydroepiandrosterone sulfate (DHEA-S) seems a better marker in clinical practice because it has a longer half-life with no circadian variation.

Serum DHEA levels may be increased in the following conditions:

• Polycystic ovary syndrome (PCOS)

• Androgen-secreting adrenal carcinoma

• Cushing syndrome (elevated adrenocorticotropic hormone [ACTH] level)

• Ectopic ACTH-secreting tumor

• Premature adrenarche

Serum DHEA levels may be decreased in the following conditions:

• Cortisol-secreting adrenal adenoma

• Adrenal insufficiency (Addison disease)

• Postmenopausal vulvovaginal atrophy ^[2]

Congenital adrenal hyperplasia

In congenital adrenal hyperplasia (CAH), the DHEA level varies with the type of the enzymatic deficiency.

Causes of increased DHEA levels in persons with CAH include the following:

• 11-hydroxylase deficiency

• 3-beta-hydroxysteroid dehydrogenase deficiency

• 21-hydroxylase deficiency

DHEA levels are normal when CAH is caused by aldosterone synthase deficiency.

Causes of decreased DHEA levels in persons with CAH include the following:

• Cholesterol side-chain cleavage enzyme deficiency

• 17-alpha-hydroxylase deficiency

Patient instruction: No need for fasting

Collection tube: Red-top tube

Specimen type: Blood serum; hemolyzed specimens are not acceptable

Collection method: Venipuncture

Specimen volume: 1 mL

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

Storage/transport temperature: Refrigerated

Stability: Refrigerated, 14 days; frozen, 7 days

Panels: None

A new technique simultaneously analyzes serum and plasma testosterone, adrenostenedione, and DHEA levels using isotope-dilution liquid-chromatography tandem mass spectrometry. ^[3]

Description

Dehydroepiandrosterone (DHEA) is a C-19 (19 carbon atoms) steroid hormone and one of three androgens (DHEA, DHEA-S, androstenedione) secreted by the adrenal gland. It is a biologically inert hormone produced from cholesterol in the zona reticularis with a rate of about 8 mg per day.

DHEA is transformed by DHEA sulfotransferase (SULT2A1) to DHEA-S, whereas steroid sulfatase can convert DHEA-S back to DHEA, possibly making DHEA-S function as a circulating storage pool. Later, DHEA is converted in the peripheral tissues to more active androgens (testosterone and dihydrotestosterone) or estrogen.

Serum DHEA concentrations decrease after birth and then begin to increase at around age 7-9 years (adrenarche) and continue increasing until the third decade of life. They then start to drop; by age 80 years, the concentration is about 20% of that at age 25 years.

Indications/Applications

The DHEA level is usually obtained with other hormones as part of the workup for the following conditions:

Hyperandrogenism

Hirsutism

Adrenal incidentaloma

Adrenal hyperplasia

Premature adrenarche

PCOS

Considerations

An abnormal DHEA level is not considered diagnostic of any disease, and it should be always measured in conjunction with other hormones.

The DHEA level can be decreased in anorexia nervosa and illness.

DHEA levels increase in association with smoking.

DHEA has been proposed to have anti-aging, anti-inflammatory, anti-atherosclerotic, and anti-depressant actions. It is available in the United States as an over-the-counter diet supplement, and it has been used in adrenal insufficiency, systemic lupus erythematosus, Sjögren syndrome, fibromyalgia, and depression, although there is not enough data to support these indications, and its safety is unknown. ^[4]

For example, studies have demonstrated benefits from DHEA supplementation in primary and secondary adrenal insufficiency, with positive effects seen on quality of life, body composition, bone health, and metabolic markers. However, questions exist concerning the role of DHEA replacement as well as which patients would most likely benefit from it. Moreover, there has been a dearth of randomized, controlled trials detailing optimal doses and replacement duration in adrenal failure. ^[5]

DHEA can be used illegally to improve athletic performance, but the National Collegiate Athletic Association (NCAA), the World Anti-Doping Agency (WADA), and other sports-governing agencies prohibit the use of DHEA.