A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA treatment effects on quality of life in women with adrenal insufficiency.
BACKGROUND
Women with primary or secondary adrenal insufficiency report a decreased health-related quality of life (HRQOL) despite traditional adrenal replacement therapy. Dehydroepiandrosterone (DHEA) has been studied as an agent to improve HRQOL in these patients.


OBJECTIVE
We sought to conduct a systematic review and meta-analysis of randomized controlled trials of DHEA effects on HRQOL in women with adrenal insufficiency.


METHODS
We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, CINAHL, and PsycInfo) and reference lists of eligible studies through July 2008.


METHODS
Eligible trials randomly assigned women with primary or secondary adrenal insufficiency to either DHEA or control and measured the effect of treatment on HRQOL.


METHODS
Reviewers working independently and in duplicate assessed the methodological quality of trials and collected data on patient characteristics, interventions, and outcomes.


RESULTS
We found 10 eligible trials that measured HRQOL and depression, anxiety, and sexual function. Random-effects meta-analysis showed a small improvement in HRQOL in women treated with DHEA compared with placebo [effect size of 0.21; 95% confidence interval, 0.08 to 0.33; inconsistency (I(2)) = 32%]. There was a small beneficial effect of DHEA on depression; effects on anxiety and sexual well-being were also small and not statistically significant.


CONCLUSIONS
DHEA may improve, in a small and perhaps trivial manner, HRQOL and depression in women with adrenal insufficiency. There was no significant effect of DHEA on anxiety and sexual well-being. The evidence appears insufficient to support the routine use of DHEA in women with adrenal insufficiency.
Department of Medicine, Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minnesota 55905, USA.
Aziz A
AA
Alkatib
Mihaela
M
Cosma
Mohamed B
MB
Elamin
Dana
D
Erickson
Brian A
BA
Swiglo
Patricia J
PJ
Erwin
Victor M
VM
Montori
D000309:Adrenal Insufficiency / Q000188:drug therapy*; D001007:Anxiety / Q000517:prevention & control; D003687:Dehydroepiandrosterone / Q000494:pharmacology / Q000627:therapeutic use*; D003863:Depression / Q000517:prevention & control; D006304:Health Status; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012725:Sexual Behavior / Q000187:drug effects; D016896:Treatment Outcome
D003687:Dehydroepiandrosterone