Dehydroepiandrosterone sulfate (DHEA-S) is a steroid hormone produced primarily by the adrenal glands, which are small glands located above the kidneys. It serves as a precursor, meaning it is converted into other important hormones, including androgens and estrogens. While the presence of DHEA-S is a normal part of the body’s hormonal landscape, elevated levels in females can sometimes signal underlying health conditions. Understanding the role of this hormone and the implications of its excess is important for overall health.
Understanding DHEA Sulfate
DHEA-S is primarily produced in the adrenal glands, with smaller amounts coming from the ovaries. It is the most abundant circulating steroid hormone in humans and acts as a reservoir for the body to create more potent hormones like testosterone and estrogen. This hormone plays a role in various physiological functions, including contributing to androgen levels, supporting bone health, and influencing libido. DHEA-S levels naturally fluctuate throughout a woman’s life, peaking in her twenties and gradually declining with age.
Common Causes of Elevated Levels
High DHEA-S levels in females can stem from several medical conditions.
Polycystic Ovary Syndrome (PCOS)
PCOS is a frequent cause, where hormonal imbalances, including elevated androgens, are characteristic. Approximately 20-30% of women with PCOS exhibit excess DHEA-S production from the adrenal glands, contributing to symptoms of hyperandrogenism. This condition often involves issues with insulin resistance.
Congenital Adrenal Hyperplasia (CAH)
CAH is a genetic disorder where specific enzyme deficiencies in the adrenal glands lead to an overproduction of DHEA-S and other adrenal hormones. While classic CAH is often diagnosed in infancy, a milder form known as non-classical CAH may not be apparent until late childhood or adulthood. In this form, the adrenal glands continuously produce excess DHEA-S due to their inability to synthesize cortisol efficiently.
Adrenal Tumors
Adrenal tumors, both benign (adenomas) and malignant (carcinomas), can also lead to elevated DHEA-S levels. These tumors can produce excessive amounts of DHEA-S. Extremely high DHEA-S levels, often five times or more above the upper limit of normal, may suggest the presence of an androgen-secreting adrenal tumor.
Recognizing Symptoms and Potential Implications
Elevated DHEA-S in females often leads to symptoms associated with androgen excess.
Physical Symptoms
Common physical signs include hirsutism (excessive hair growth in male-pattern areas), severe acne, and hair loss or thinning of the scalp.
Reproductive Symptoms
Menstrual irregularities are another frequent symptom, ranging from infrequent periods (oligomenorrhea) to a complete absence of periods (amenorrhea). These disruptions can affect fertility. Very high DHEA-S levels can also lead to other physical changes, including deepening of the voice and increased muscle mass. Weight gain is also associated with underlying conditions that cause elevated DHEA-S, such as PCOS.
Long-Term Health Risks
If elevated DHEA-S levels remain unaddressed, there can be long-term health implications. Conditions like PCOS, which often involve high DHEA-S, are linked to an increased risk for metabolic issues. These can include insulin resistance, which may progress to type 2 diabetes. There is also an association with cardiovascular concerns.
Diagnosis and Treatment Approaches
Diagnosing elevated DHEA-S levels begins with a blood test to measure the hormone’s concentration. If DHEA-S levels are found to be high, further tests are necessary to pinpoint the underlying cause, as an elevated level alone does not specify a diagnosis.
Diagnostic Tests
These additional tests might include:
Other hormone measurements, such as testosterone and 17-hydroxyprogesterone.
Imaging scans like an ultrasound of the ovaries or an MRI/CT scan of the adrenal glands to look for tumors or hyperplasia.
Consulting a medical professional, particularly an endocrinologist, is important for proper diagnosis and interpretation of results.
Treatment Approaches
Treatment for high DHEA-S levels focuses on addressing the specific underlying cause identified through diagnosis.
Polycystic Ovary Syndrome (PCOS): Treatment often involves lifestyle modifications, such as dietary changes and regular exercise, to help manage insulin resistance and weight. Medications like oral contraceptives can regulate menstrual cycles and reduce androgen-related symptoms, while anti-androgen drugs, such as spironolactone, may be prescribed to block androgen effects.
Congenital Adrenal Hyperplasia (CAH): Hormone replacement therapy, often with glucocorticoids like dexamethasone, is used to suppress the adrenal glands’ overproduction of DHEA-S. This helps to normalize hormone levels and prevent symptoms.
Adrenal Tumors: If an adrenal tumor is the cause, surgical removal of the tumor is typically the recommended course of action.
Treatment plans are highly individualized, depending on the specific diagnosis, symptom severity, and overall health goals, and always require ongoing medical supervision.