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DHEA-S (DHS)

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EPIC Test Name

DHEA-SULFATE

EPIC Code

LAB524

Specimen Requirements

plasma
Minimum Volume:0.5 mL
Collection:Collect using standard laboratory procedures
Transport:Room Temperature ASAP
Stability:Room Temperature: 5 days at 20-25 degrees C
Refrigerated: 14 days at 4-8 degrees C
Frozen: 12 months at -20 degrees C
Container:LIT-GRN
Processing/Storage:Centrifuge pour off and freeze.
Rejection Causes:Hemolysis,
Insufficient Sample Volume, lipemic samples

Methods

Electrochemiluminescence

Turnaround Time

SpecimenTurnaround TimeFrequency
plasma5 daysRun Tuesdays and Fridays

Reference Ranges

Electrochemiluminescence
AgeAll RangeMale RangeFemale RangeUnit
1 year up to 5 years<19ug/dL
5 years up to 10 years<85
10 years up to 15 years<247<280
15 years up to 20 years<368
20 years up to 25 yeas<407
15 years up to 25 years<492
25 years up to 45 years<440<340
45 years up to 55 years<331
45 years up to 75 years<250
55 years up to 75 years<295
75 years to 999 years<123<154

Clinical Indications

Dehydroepiandrosterone (DHEA) is synthesized and secreted in the adrenal glands, that is regulated via hypothalamus-pituitary-adrenal axis. The majority of DHEA exists in the circulation protein-bound form and as 3-sulfoconjugate (DHEA-S). At the gonads and other peripheral tissues, steroid sulfatases reverse DHEA-S to DHEA, which can then be metabolized to stronger androgens and to estrogens.
During pregnancy, fetal adrenal glands produce DHEA-S in large quantities, serving as precursors for placental production of the dominant pregnancy estrogen, estriol. After birth, DHEA-S levels gradually fall by 80% or more and remain low until the onset of adrenarche. Early adrenarche in females may have an increased risk of polycystic ovarian syndrome, and in some boys may develop early penile enlargement.
After birth, DHEA-S levels increase and peak around the age of 20, then gradually decline over the next 40 to 60 years to around 20% of the peak level. There has been no direct evidence showing the clinical significance of the age-related DHEA-S decrease, except, for patients with primary adrenal failure, the addition of DHEA-S to corticosteroid replacement has shown improvements in patients’ mood, energy and sex drive in some studies.
Measurements of DHEA or DHEA-S, in serum and plasma are useful for investigations of adrenal androgen production, such as assessment of adrenal hyperplasia, adrenal tumors, adrenarche, delayed puberty, or hirsutism.
DHEA concentrations exhibit a circadian rhythm as its secretion is regulated by ACTH, and their concentrations vary in the menstrual cycle. In contrast, DHEA-S concentrations do not exhibit a circadian rhythm due to its longer circulating half-life.

Additional Information

• Patients with increased DHEAS concentrations should be checked on if DHEA-containing supplement is being taken.
• Drugs may significantly increase or decrease circulating concentrations of DHEAS. For instance, dexamethasone, affect the HPA axis by inhibiting ACTH and therefore decrease DHEA and DHEA-S concentrations. Carbamazepine and phenytoin induce the P450 enzymes metabolizing DHEA and DHEA-S and therefore decrease DHEAS concentrations. Danazol, a sulfatase inhibitor, alters the ratio of DHEA to DHEA-S.
• Patients who have been regularly exposed to animals or have received immunotherapy or diagnostic procedures utilizing immunoglobulins or immunoglobulin fragments may produce antibodies, e.g. HAMA, that interfere with immunoassays.

Common Synonyms

DHS DHEAS

Performed

Lab
Chemistry - Community

Interpretative Information

• Most mild to moderate elevations in DHEA-S levels are often idiopathic.
• Significant elevations of DHEA-S may suggest androgen-producing adrenal tumors.
• In children, elevated DHEA-S levels occur to patients with congenital adrenal hyperplasia (CAH) due to 3-beta-hydroxysteroid dehydrogenase (3-beta-HSD) deficiency, lesser level of elevations may be observed in 21-hydroxylase deficiency and 11 beta-hydroxylase deficiency. DHEA-S values should NOT be used as the primary biomarker for CAH diagnosis.
• Patients with steroidogenic acute regulatory protein or 17 alpha-hydroxylase deficiencies have low DHEA-S levels.
• Patients with polycystic ovary disease often have elevated DHEA-S values.
• Normal levels of DHEAS can often be seen in patients with virilizing ovarian tumors.

CPT

82627

LOINC

2191-5

References

1. Force B, Gupta M, Balazs A. SAT-289 An Unusual Virilizing Ovarian Tumor in Adolescence. J Endocr Soc. 2019;3(Suppl 1):SAT-289. Published 2019 Apr 30. doi:10.1210/js.2019-SAT-289
2. RJ Norman, D Dewailly, RS Legro, et al.: Polycystic ovary syndrome. Lancet. 370:685-697 2007 17720020
3. DN Orth, WJ Kovacs: The adrenal cortex. RH Williams DW Foster HM Kronenberg et al. Williams textbook of endocrinology. 9th ed 1998 W.B. Saunders Philadelphia 517-664
4. Sciarra F, Tosti-Croce C, Toscano V: Androgen-secreting adrenal tumors. Minerva Endocrinol 1995;20:63-8
5. Collett-Solberg P: Congenital adrenal hyperplasia: from genetics and biochemistry to clinical practice, part I. Clin Pediatr 2001;40:1-16
6. Salek FS, Bigos KL, Kroboth PD: The influence of hormones and pharmaceutical agents on DHEA and DHEA-S concentrations: a review of clinical studies. J Clin Pharmacol 2002;42:247-266
7. Elmlinger MW, Kuhnel W, Ranke MB: Reference ranges for serum concentrations of lutropin (LH), follitropin (FSH), estradiol (E2), prolactin, progesterone, sex hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA-S), cortisol and ferritin in neonates, children, and young adults. Clin Chem Lab Med 2002;40(11):1151-60.

Contact Information

Chemistry - Community: (315)492-5531
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