Dehydroepiandrosterone sulfate (DHEAS)

DHEAS testing, along with other tests, is used to evaluate adrenal function and to help diagnose tumours in the cortex of the adrenal gland (adrenocortical tumours, including cancers) and congenital adrenal hyperplasia or adult-onset adrenal hyperplasia. DHEAS testing can also be used to help doctors decide whether excess androgens are being secreted by the adrenal glands or by the ovaries or testes.

Concentrations of DHEAS are often measured, along with other hormones such as FSH, LH, prolactin, oestrogen, and testosterone, to help diagnose polycystic ovarian syndrome (PCOS) and to help rule out other causes of infertility, amenorrhoea, and hirsutism.

DHEAS levels may be ordered, along with other hormones, to investigate and diagnose the cause of virilisation in young girls and early (precocious) puberty in young boys.

DHEAS levels are not routinely measured. A DHEAS test may be ordered, along with other hormone tests, whenever excess (or, more rarely, deficient) androgen production is suspected and/or when a doctor wants to evaluate a person's adrenal gland function.

It may be measured when a woman presents with signs and symptoms such as amenorrhoea, infertility, and/or those related to virilisation. These changes vary in severity and may include:

• A deeper voice
• Hirsutism
• Male pattern baldness
• Muscularity
• Acne
• Enlargement of the Adam's apple
• Decreased breast size

It may also be ordered when a young girl shows signs of virilisation, such as hirsutism, a deep voice, or when a female infant has ambiguous genitalia, meaning that there is a birth defect of the genitals that make it difficult to tell whether a newborn baby is a boy or a girl.  

DHEAS may also be measured when young boys show signs of precocious puberty (the development of a deeper voice, pubic hair, muscularity and an enlarged penis well before the age of normal puberty).

A normal DHEAS level, along with other normal androgen levels, may indicate that the adrenal gland is functioning normally. Rarely, DHEAS may be normal when an adrenal tumour is present but is not secreting hormones. With polycystic ovarian syndrome, DHEAS may be elevated but may also be normal as this disorder is usually related to increased production of other androgens by the ovaries (primarily testosterone).

An increased level of DHEAS is not diagnostic of a specific condition; it usually indicates the need for further testing to pinpoint the cause of the hormone imbalance.

A low level of DHEAS may be due to adrenal insufficiency, adrenal dysfunction, Addison’s disease or hypopituitarism, a condition that causes decreased levels of the pituitary hormones that regulate the production and secretion of adrenal hormones. Some medications, particularly corticosteroids or oestrogen supplements, may reduce the level of DHEAS in the blood.

DHEAS levels are normally high in both male and female newborns. They drop sharply shortly after birth, then rise again during puberty. DHEAS concentrations peak after puberty, and then, like other male and female hormones, the levels tend to decline with age.

People taking DHEA supplements will have elevated blood levels of DHEAS. Certain antidiabetic drugs (such as metformin and troglitazone), prolactin, danazol, calcium channel blockers, and nicotine may also increase DHEAS levels. Drugs/hormones that may cause decreased inducers (carbamezepine, imipramine, phenytoin), fish oil, and vitamin E. It is important to inform your healthcare provider when taking any of these products.

Some hormones are increased in the morning while others rise and fall throughout the day. Some are released intermittently or with increased activity or in response to stress. Some hormones are higher at particular times of the month, and others are relatively stable. Blood sample collection for some hormone tests are timed so that the hormones can be evaluated at their highest or lowest levels. The DHEAS concentration, however, is stable, so your sample may be collected any time or day and it will not affect the result of the test.

Not necessarily. It may be difficult to determine when adult men have an elevated level of DHEAS (since they already have masculine secondary sexual characteristics) and women of some ethnic groups (for example, Asian women) may have elevated levels of testosterone and DHEAS without exhibiting symptoms such as excess hair growth or acne.  Also, it should be noted that the symptoms present and their severity will vary from person to person.