DHEA-Sulphate (DHEAS)

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Preferred marker in blood tests for assessing adrenal androgen function

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DHEA-Sulphate (DHEAS) Test Information Guide

Why is it done?
- Test Description: DHEA-S (dehydroepiandrosterone sulphate) is a weak male hormone (androgen) produced primarily by the adrenal glands. This test measures the level of DHEA-S in the blood to assess adrenal gland function and hormonal balance.
- Primary Indications: Evaluating adrenal insufficiency or Addison's disease; assessing excess androgen production; investigating hirsutism, acne, or male pattern baldness in women; evaluating infertility; assessing polycystic ovary syndrome (PCOS); investigating irregular menstrual cycles; evaluating early puberty or delayed puberty; assessing adrenal tumors; monitoring aging-related hormone decline
- Typical Timing: Morning collections are preferred (7-9 AM); for women, testing typically occurs in the follicular phase of the menstrual cycle; may be ordered during investigation of endocrine disorders or during routine hormonal assessments
Normal Range
- Reference Ranges (vary by laboratory and method):
- Adult Males: 160–450 μg/dL or 4.4–12.3 μmol/L
- Adult Females (follicular phase): 45–270 μg/dL or 1.2–7.3 μmol/L
- Postmenopausal Women: 30–120 μg/dL or 0.8–3.3 μmol/L
- Children (age-dependent): Ranges vary significantly with age; typically much lower in young children, increasing through puberty
- Units of Measurement: μg/dL (micrograms per deciliter) or μmol/L (micromoles per liter)
- Interpretation of Results: Normal: Levels within established reference range indicate appropriate adrenal function; Low: Below normal range suggests adrenal insufficiency; High: Above normal range may indicate adrenal hyperplasia, Cushing's syndrome precursor, or androgen-secreting tumors
Interpretation
- Elevated DHEA-S Levels: May indicate congenital adrenal hyperplasia (CAH), adrenal tumor, Cushing's syndrome, PCOS in women, hirsutism, virilization, polycystic ovary disease, or rarely ectopic hormone production; mild elevation may be normal variation or age-related changes
- Low DHEA-S Levels: Suggests adrenal insufficiency, Addison's disease, hypopituitarism, pituitary failure, severe illness or stress, aging (expected decline after age 30), certain medications (corticosteroids), or adrenal gland disease
- Factors Affecting Readings: Time of day (higher in morning), menstrual cycle phase (women), age (peak levels mid-20s, decline with age), stress levels, illness, medications (corticosteroids, oral contraceptives), pregnancy, obesity, smoking, and laboratory methodology variations
- Clinical Significance: DHEA-S is more stable throughout the day than DHEA, making it a reliable marker for adrenal function; it serves as a precursor to testosterone and estrogen; abnormal levels require correlation with other hormonal tests (cortisol, ACTH, testosterone, 17-hydroxyprogesterone) and clinical presentation for accurate diagnosis
- Result Patterns: High DHEA-S with high testosterone/androstenedione: suggests CAH or adrenal tumor; Low DHEA-S with low cortisol: suggests primary adrenal insufficiency; Low DHEA-S with normal cortisol: may indicate secondary adrenal insufficiency or aging; Variable DHEA-S requires additional testing for definitive diagnosis
Associated Organs
- Primary Organs Involved: Adrenal glands (zona reticularis and fasciculata); pituitary gland (controls ACTH secretion); hypothalamus (regulates pituitary function); reproductive organs (target tissues for androgen and estrogen)
- Medical Conditions Associated with Abnormal Results:
- High Levels: Congenital adrenal hyperplasia (21-hydroxylase deficiency most common), adrenocortical carcinoma, benign adrenal adenoma, Cushing's syndrome, PCOS, ovarian androgen-secreting tumors, adrenal virilizing tumors, early-onset hirsutism
- Low Levels: Primary adrenal insufficiency (Addison's disease), secondary adrenal insufficiency, hypopituitarism, pituitary adenomas, hypothyroidism effects, sepsis, critical illness, myocardial infarction, tuberculosis affecting adrenals, autoimmune adrenalitis
- Potential Complications of Abnormal Results: Untreated adrenal insufficiency: cardiovascular collapse, electrolyte imbalance, hypoglycemia, shock; Untreated excess androgens: virilization, infertility, hirsutism, metabolic dysfunction; Adrenal tumors: potential malignancy, hormone-related complications; Chronic hyperandrogenism: insulin resistance, type 2 diabetes, cardiovascular disease
Follow-up Tests
- If DHEA-S is Elevated: Testosterone (total and free), 17-hydroxyprogesterone, androstenedione, 17-ketosteroids, ACTH stimulation test, dexamethasone suppression test, pelvic ultrasound, abdominal/adrenal imaging (CT or MRI), ovarian ultrasound, LH/FSH ratio assessment
- If DHEA-S is Low: Morning cortisol, ACTH level, ACTH stimulation (Cosyntropin) test, 24-hour urinary cortisol, insulin tolerance test, CRH stimulation test, TSH, free T4, pituitary imaging (MRI), assessment for tuberculosis or autoimmune disease
- Complementary Testing: Estradiol, progesterone, FSH, LH, prolactin, glucose, electrolytes (sodium, potassium), insulin levels, lipid panel, metabolic panel, blood pressure monitoring
- Monitoring Frequency: For adrenal insufficiency: every 3-6 months during initial stabilization, then annually; For CAH or adrenal tumors: follow oncology/endocrinology recommendations; For PCOS: annual screening; For hormone replacement therapy monitoring: as determined by treating physician
- Imaging Studies: CT scan of adrenals (for tumors or hyperplasia), MRI of pituitary (for hypothalamic-pituitary disorders), pelvic ultrasound (for ovarian pathology), abdominal imaging as clinically indicated
Fasting Required?
- Fasting Requirement: No, fasting is NOT required for DHEA-S testing
- Collection Timing: Blood should be drawn in the morning (between 7-9 AM preferred) as DHEA-S follows a diurnal rhythm with higher levels in early morning; consistent timing for serial measurements is important for comparison
- Menstrual Cycle Consideration (Women): For premenopausal women, testing in the follicular phase (days 3-5 of menstrual cycle) is preferred for standardization, though DHEA-S does not vary significantly with cycle phase
- Medications to Avoid/Disclose: Corticosteroids (prednisone, dexamethasone, hydrocortisone): lower DHEA-S levels; Oral contraceptives: may lower levels; Hormone replacement therapy: disclose to provider; Spironolactone: may affect results; Other medications: inform technician of all medications being taken
- Patient Preparation Instructions: Schedule appointment in early morning if possible; eat and drink normally (fasting not required); drink adequate water day before and morning of test; avoid strenuous exercise 24 hours before test; minimize stress the day of testing (stress elevates cortisol and may affect DHEA-S); arrive at least 10-15 minutes early; bring insurance card and photo ID; inform phlebotomist of any recent illness or medications
- Special Considerations: Recent illness or hospitalization may temporarily affect levels; pregnancy affects interpretation; aging significantly lowers DHEA-S; smoking may influence results; obesity associated with lower levels; adequate sleep night before improves accuracy of testing

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