DHEA, DHEA sulfate, and androstenedione are three precursors of androgens and estrogens. DHEA secreted from the adrenal cortex has minimal direct biological activity. Adrenal DHEA is rapidly conjugated with sulfate to form DHEA sulfate. The plasma concentration of DHEA sulfate (DHEA-S) is 1000 times higher than unconjugated DHEA. Measurement of plasma DHEA-S levels is useful in investigation of hirsutism and amenorrhea in women and diagnosis of androgen secreting adrenal tumors.
Elevated plasma levels may indicate hyperandrogenism from an adrenal tumor or congenital adrenal hyperplasia. In congenital adrenal hyperplasia caused by 3-beta hydroxysteroid deficiency, 11-beta hydroxylase deficiency, or 21-beta hydroxylase deficiency, elevated ACTH secretion increases the DHEA level, which results in premature penile enlargement and early secondary sexual characteristics in boys and hirsutism and virilization in girls.
Plasma levels are often increased in women with hirsutism and polycystic ovarian disease. DHEA-S may also be increased in women with amenorrhea.
Elevated plasma levels may also be caused by DHEA rich food extracts such as Mexican yams and beef adrenal glands. DHEA supplements can be purchased in health food stores.
DHEA-S is measured by a competitive binding enzyme immunoassay. Reference range is gender and age dependent and declines with advancing age.
Specimen requirement is a plain red top tube of blood collected before 10:30 a.m.
References
Collett-Solberg P. Congenital adrenal hyperplasia: from genetics and biochemistry to clinical practice, part I. Clin Pediatr, 2001;40(1):1-16.
Charoensri S, et al. Serum dehydroepiandrosterone sulfate in assessing the integrity of the hypothalamic-pituitary-adrenal axis. J Clin Transl Endocrinol. 2017;7:42-46.
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