This article is more than 5 years old. Information may no longer be current.
Experts: Consider DHEA levels when assessing adrenal function
Click Here to Manage Email Alerts
Dehydroepiandrosterone levels are low among patients with adrenal insufficiency, both at baseline and after low-dose cosyntropin stimulation, according to data from researchers in Ohio. Therefore, they recommend measuring dehydroepiandrosterone and dehydroepiandrosterone sulfate levels when assessing hypothalamic-pituitary-adrenal function.
The prospective study aimed to determine whether testing dynamic measurements of DHEA during low-dose cosyntropin stimulation was a valuable addition to the evaluation for hypothalamic-pituitary-adrenal (HPA) function. Researchers measured baseline and low-dose cosyntropin-stimulated cortisol, DHEA and DHEA sulfate (DHEA-S) before surgery in 155 patients with pituitary masses and 63 healthy people.
Ninety-seven patients had normal HPA function and 58 patients had impaired HPA function. The sellar masses were removed in those with normal HPA function, and these patients did not receive glucocorticoids before, during or after surgery.
Patients with impaired HPA had lower baseline and low-dose cosyntropin-stimulated cortisol, DHEA and DHEA-S compared with patients with normal HPA function and healthy people, whose levels were similar. However, 18 patients with impaired HPA had low-dose cosyntropin-stimulated serum cortisol levels of at least 18 mcg/dL, but their baseline low-dose cosyntropin-stimulated DHEA and DHEA-S levels were similar to the rest of the patients with impaired HPA.
Low-dose cosyntropin stimulation had no effect on the molar ratio of cortisol to DHEA in healthy people or patients with normal HPA. Those with impaired HPA, however, had a higher baseline cortisol to DHEA molar ratio that increased with low-dose cosyntropin stimulation, the researchers wrote.
“We believe that measurements of baseline serum DHEA-S levels are very valuable in the assessment of HPA function and a normal age- and gender-adjusted level makes the diagnosis of [adrenal insufficiency] extremely unlikely,” the researchers wrote. “We therefore recommend the inclusion of DHEA and DHEA-S measurements in the laboratory evaluation of HPA function, particularly in subjects who achieve borderline cortisol responses with [low-dose cosyntropin] stimulation.”
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts