Dehydroepiandrosterone (DHEA) Sulfate

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.

Normal findings

See the table below.

Table. Reference Ranges for DHEA-S ^[1] (Open Table in a new window)

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) ^[2]

• Ectopic ACTH secreting tumor

• Premature adrenarche ^[3]

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

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

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. ^{[4, 5]}

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:

• Hyperandrogenism

• Hirsutism

• Adrenal incidentaloma

• Adrenal hyperplasia

• Premature adrenarche

• PCOS

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.