The value of dehydroepiandrosterone sulfate measurements in the assessment of adrenal function.
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 micro g, 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 micro g/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.
Nasrallah
Mona P
MP
Division of Clinical and Molecular Endocrinology, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio 44106, USA.
Arafah
Baha M
BM
D000236:Adenoma / Q000097:blood; D000311:Adrenal Glands / Q000502:physiology*; D000309:Adrenal Insufficiency / Q000097:blood* / Q000175:diagnosis*; D000328:Adult; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies
D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone