Dehydroepiandrosterone Sulfate


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Dehydroepiandrosterone Sulfate

Synonym/acronym: DHEAS.

Common use

To assist in identifying the cause of infertility, amenorrhea, or hirsutism.

Specimen

Serum (1 mL) collected in a red- or red/gray-top tube. Plasma (1 mL) collected in a lavender-top (EDTA) tube is also acceptable. Place separated serum into a standard transport tube within 2 hr of collection.

Normal findings

(Method: Immunochemiluminometric assay [ICMA])
AgeMale Conventional Units mcg/dLMale SI Units micromol/L (Conventional Units × 0.027)Female Conventional Units mcg/dLFemale SI Units micromol/L (Conventional Units × 0.027)
Newborn108–6072.9–16.4108–6072.9–16.4
7–30 d32–4310.9–11.632–4310.9–11.6
1–5 mo3–1240.1–3.33–1240.1–3.3
6–35 mo0–300–0.80–300–0.8
3–6 yr0–500–1.40–500–1.4
7–9 yr5–1150.1–3.15–940.1–2.5
10–14 yr22–3320.6–922–2550.6–6.9
15–19 yr88–4832.4–1363–3731.7–10
20–29 yr280–6407.6–17.365–3801.8–10.3
30–39 yr120–5203.2–1445–2701.2–7.3
40–49 yr95–5302.6–14.332–2400.9–6.5
50–59 yr70–3101.9–8.426–2000.7–5.4
60–69 yr42–2901.1–7.813–1300.4–3.5
70 yr and older28–1750.8–4.710–900.3–2.4
Tanner StageMale Conventional Units mcg/dLMale SI Units micromol/L (Conventional Units × 0.027)Female Conventional Units mcg/dLFemale SI Units micromol/L (Conventional Units × 0.027)
I7–2090.2–5.67–1260.2–3.4
II28–2600.8–713–2410.4–6.5
III39–3901.1–10.532–4460.9–12
IV & V81–4882.2–13.265–3711.8–10

Description

Dehydroepiandrosterone sulfate (DHEAS) is the major precursor of 17-ketosteroids. DHEAS is a metabolite of DHEA, the principal adrenal androgen. DHEAS is primarily synthesized in the adrenal gland, with a small amount secreted by the testes. DHEAS is a weak androgen and can be converted into more potent androgens (e.g., testosterone) as well as estrogens (e.g., estradiol). It is secreted in concert with cortisol, under the control of adrenocorticotropic hormone (ACTH) and prolactin. Excessive production causes masculinization in women and children. DHEAS has replaced measurement of urinary 17-ketosteroids in the estimation of adrenal androgen production.

This procedure is contraindicated for

    N/A

Indications

  • Assist in the evaluation of androgen excess, including congenital adrenal hyperplasia, adrenal tumor, and Stein-Leventhal syndrome
  • Evaluate women with infertility, amenorrhea, or hirsutism

Potential diagnosis

Increased in

  • DHEAS is produced by the adrenal cortex and testis; therefore, any condition stimulating these organs or associated feedback mechanisms will result in increased levels.

  • Anovulation
  • Cushing’s syndrome
  • Ectopic ACTH-producing tumors
  • Hirsutism
  • Hyperprolactinemia
  • Polycystic ovary (Stein-Leventhal syndrome)
  • Virilizing adrenal tumors

Decreased in

    DHEAS is produced by the adrenal cortex and testis; therefore, any condition suppressing the normal function of these organs or associated feedback mechanisms will result in decreased levels.

    Addison’s disease Adrenal insufficiency (primary or secondary) Aging adults (related to natural decline in production with age) Hyperlipidemia Pregnancy (related to DHEAS produced by fetal adrenals and converted to estrogens in the placenta) Psoriasis (some potent topical medications used for long periods of time can result in chronic adrenal insufficiency) Psychosis (related to acute adrenal insufficiency)

Critical findings

    N/A

Interfering factors

  • Drugs that may increase DHEAS levels include aloin, benfluorex, clomiphene, corticotropin, danazol, exemestane, gemfibrozil, metformin, mifepristone, and nitrendipine.
  • Drugs that may decrease DHEAS levels include aspirin, carbamazepine, dexamethasone, exemestane, finasteride, ketoconazole, leuprolide, oral contraceptives, phenobarbital, phenytoin, and tamoxifen.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching:   Inform the patient this test can assist in diagnosing the cause of hormonal fluctuations.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s endocrine system, symptoms, phase of menstrual cycle, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values).
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues,  as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include ACTH, cortisol, prolactin, and testosterone.
  • Refer to the Endocrine System table at the end of the book for related tests by body system.
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References in periodicals archive ?
The delayed administration of dehydroepiandrosterone sulfate improves recovery of function after traumatic brain injury in rats.
Low dehydroepiandrosterone sulfate is associated with increased risk of ischemic stroke among women.
2] The endocrinological data of myelolipoma associated with hyperandrogenemia showed significantly increased plasma testosterone and dehydroepiandrosterone sulfate (DHEAS), and the histological study showed myelolipoma elements and hyperplasia of zona reticularis of adrenal cortex (Fig.
Linoleic acid, oleic acid, and dehydroepiandrosterone sulfate were the most powerful markers.
In an article published in the American Heart Association journal Stroke, researchers from Brigham Women's Hospital and Harvard School of Public Health report an association between lower levels of the hormone dehydroepiandrosterone sulfate (DHEAS) and a greater risk of stroke in older women.
A subset of androgens, adrenal androgens, includes any of the 19-carbon steroids synthesized by the adrenal cortex, the outer portion of the adrenal gland (zonula reticularis--innermost region of the adrenal cortex), that function as weak steroids or steroid precursors, including dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione.
Measurement of serum levels of dehydroepiandrosterone sulfate (DHEAS), androstenedione, prolactin, and sex-hormone-binding globulin (SHBG) can facilitate diagnosis.
Follow-up screening can also include thyroid studies to evaluate for hypothyroidism and dehydroepiandrosterone sulfate, free testosterone, and a luteinizing hormone to follicle-stimulating hormone (LH:FSH) ratio to screen for hyperandrogenism.
Levels of total and free testosterone and dehydroepiandrosterone sulfate were also similar for the two groups.
Average dehydroepiandrosterone sulfate (DHEA-S) fell 26% in the OCP/simvastatin patients and 28% in the OCP-alone group.
Hirsutism with unremarkable history and physical exam findings should be evaluated with a serum total testosterone and dehydroepiandrosterone sulfate (DHEAS) level (SOR: B, based on a cohort study in a referral population).