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.
Normal findings
See the table below.
Table. Reference Ranges for DHEA-S [1] (Open Table in a new window)
Tanner stage |
Male |
Female |
Stage I |
7-126 mcg/dL |
7-209 mcg/dL |
Stage II |
13-241 mcg/dL |
28-260 mcg/dL |
Stage III |
32-446 mcg/dL |
39-390 mcg/dL |
Stage IV-V |
65-371 mcg/dL |
81-488 mcg/dL |
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) [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
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
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. [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
-
Adrenal incidentaloma
-
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.