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The Value of Dehydroepiandrosterone Sulfate Measurements in the Assessment of Adrenal Function

Division of Clinical and Molecular Endocrinology, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio 44106

Address all correspondence and requests for reprints to: Baha M. Arafah, M.D., Division of Clinical and Molecular Endocrinology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106. E-mail: bxa{at}po.cwru.edu.

Dehydroepiandrosterone (DHEA) and its sulfated ester (DHEA-S) are corticotropin-dependent adrenal androgen precursors that are uniformly low in treated patients with corticotropin deficiency. There are no data investigating the diagnostic value of DHEA-S measurements in the prospective assessment of adrenal function. This study examined serum DHEA-S levels as possible markers for hypothalamic- pituitary-adrenal (HPA) function in patients with large pituitary adenomas.

Patients were characterized to have normal HPA (n = 47) or abnormal HPA (ABN-HPA, n = 35) function based on their respective responses to insulin-induced hypoglycemia. Patients also underwent low-dose Cortrosyn (1 µg, LDC) and standard-dose Cortrosyn stimulation testing.

All patients with ABN-HPA had very low age- and gender-matched serum DHEA-S levels. When the normal response to LDC was set at a cortisol level of at least 18.1 µg/dl, 10 of 31 patients with ABN-HPA exhibited normal responses. Receiver operating characteristic curves for baseline DHEA-S and for maximal cortisol responses to LDC had areas of 0.984 (confidence interval, 0.962–1.000) and 0.893 (confidence interval, 0.817–0.969), respectively.

LDC- or SDC-stimulated serum cortisol levels have significant limitations in defining HPA function. A normal age- and gender-specific serum DHEA-S level makes the diagnosis of corticotropin deficiency extremely unlikely. However, when serum DHEA-S levels are low, further testing is necessary to define HPA function.

This work was conducted and supported by a grant to the General Clinical Research Center of Case Western Reserve University.

A preliminary report of the data was presented at the 83rd Annual Meeting of The Endocrine Society, Denver, CO, 2001.

Abbreviations: ABN-HPA, Abnormal HPA; CI, confidence interval; DHEA, dehydroepiandrosterone; DHEA-S, DHEA sulfate; HPA, hypothalamic-pituitary-adrenal; IIH, insulin-induced hypoglycemia; LDC, low-dose Cortrosyn; NL-HPA, normal HPA; PRL, prolactin; ROC, receiver operating characteristic; SDC, standard-dose Cortrosyn.

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