DHEA has very low androgenic potency but serves as the major direct or indirect precursor for most sex steroids. DHEA is secreted by the adrenal gland, and production is at least partly controlled by ACTH; the bulk of DHEA is secreted as a 3-sulfoconjugate DHEA-S. Both hormones are albumin bound, but DHEA-S binding is much tighter. As a result, circulating concentrations of DHEA-S are much higher (>100-fold) compared to DHEA. In most clinical situations, DHEA and DHEA-S results can be used interchangeably. In gonads and several other tissues, most notably skin, steroid sulfatases can convert DHEA-S back to DHEA, which can then be metabolized to stronger androgens and to estrogens. During pregnancy, DHEA/DHEA-S and their 16-hydroxylated metabolites are secreted by the fetal adrenal gland in large quantities. They serve as precursors for placental production of the dominant pregnancy estrogen, estriol. Within weeks after birth, DHEA/DHEA-S levels fall by 80% or more and remain low until the onset of adrenarche at age 7 or 8 in girls and age 8 or 9 in boys.
Normal range (adults): male: 180 " “1,250 ng/dL; female: 130 " “980 ng/dL.
Use
Diagnosing and differential diagnosis of hyperandrogenism (in conjunction with measurements of other sex steroids).
An adjunct in the diagnosis of CAH; DHEA/DHEA-S measurements play a secondary role to the measurements of cortisol/cortisone, 17α-hydroxyprogesterone, and androstenedione.
Diagnosing and differential diagnosis of premature adrenarche.
Interpretation
Increased In
Hyperandrogenism
Androgen-producing adrenal tumors
CAH due to 3 Ž ²-hydroxysteroid dehydrogenase deficiency
Decreased In
With age in men and women, hyperlipidemia, psychosis, psoriasis
Limitations
DHEA levels increase until the age of 20 to a maximum roughly comparable to that observed at birth. Levels then decline over the next 40 " “60 years to around 20% of peak levels.
Currently, the correlation of serum DHEA/DHEA-S level with disease risk factors has not been completely established. There are currently no established guidelines for DHEA replacement/supplementation therapy or its biochemical monitoring.