The measurement of DHEAS is used very infrequently in the UK as it has been found that other tests are more helpful. A doctor may measure DHEAS in those with signs or symptoms that may be due to the presence or too much male hormone.
It is sometimes used in the investigation of Cushing’s syndrome.
A blood sample taken from a vein in your arm
No test preparation is needed
Dehydroepiandrosterone Sulphate (DHEAS) is the sulphated form of a weak androgen, DHEA, a male sex hormone that is present in the blood of both men and women. It has a role to play in developing male secondary sexual characteristics at puberty, and it can be changed by the body into stronger androgens, such as testosterone and androstenedione, or can be changed into the female hormone oestrogen. DHEAS is produced by the adrenal cortex, the outer layer of the adrenal glands, with much smaller amounts being produced by the woman's ovaries and man's testes. DHEAS secretion is controlled by the pituitary hormone adrenocorticotropic hormone (ACTH) and by other pituitary factors.
Since DHEAS is primarily produced by the adrenal glands, it is useful as a marker for adrenal function. Adrenal cancers, and hyperplasia (excessive growth) can lead to the overproduction of DHEAS but is frequently inappropriately low when an adrenal tumour is present. While elevated concentrations may not be noticed in adult men, they can lead to amenorrhoea and visible symptoms of virilisation in women. These changes vary in severity and may include:
- a deeper voice
- hirsutism (increased facial and/or body hair)
- male pattern baldness
- increased muscularity
- enlargement of the Adam’s apple
DHEAS may be useful in the investigation of precocious puberty in some boys but only in girls precocious puberty associated with signs of virilisation. DHEAS may also be used in the specialist investigation of disorders of sex development such as in babies with ambiguous genitalia (when difficult to determine whether baby is boy or girl) or at any point thereafter.
A distinct period of puberty, which can occur before the other stages, is called adrenarche. This is activation of the adrenal gland before the ovaries or testicles where a surge of adrenal androgens, primarily DHEAS, can result in some body hair and the change to adult body odour (sweat starts to smell). Premature (early) adrenarche is mostly benign and is more common in girls and children of South Asian and Afro-Caribbean origin.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
How is it used?
DHEAS concentrations are not routinely measured. Unless you have symptoms that warrant its use, you will most likely never have a DHEAS test done. DHEAS can be measured to help diagnose adrenal conditions.
More commonly other hormones such as FSH, LH, prolactin, oestrogen, and testosterone are measured to diagnose polycystic ovarian syndrome (PCOS) and to help rule out other causes of infertility, amenorrhea, virilisation and hirsutism. The measurement of DHEAS is not recommended in NICE guidance for either infertility or PCOS investigation.
DHEAS concentrations may be requested in the investigation of disorders of sex development such as ambiguous genitalia in babies and in boys showing early puberty.
When is it requested?
A DHEAS test may be requested with other hormone tests when excess androgen (male hormone) production is suspected. This will be apparent by either precocious puberty in boys or hirsutism or virilisation in women. DHEAS concentrations may be used in the investigation of disorders of sex development. If an enzyme deficiency is present that causes increased DHEAS in such cases then the hormone may be requested to monitor treatment.
What does the test result mean?
Low concentrations of DHEAS may be due to adrenal dysfunction or hypopituitarism - a condition that causes decreased levels of the pituitary hormones that regulate the production and secretion of adrenal hormones. Normal DHEAS concentrations, along with normal concentrations of other androgens, may indicate that the adrenal gland is functioning normally or (more rarely) that an adrenal tumour or cancer present is not secreting hormones. Normal concentrations of DHEAS are frequently seen with PCOS, as this disorder is usually related to ovarian androgen production (primarily testosterone).
Elevated concentrations of DHEAS may indicate an adrenal cancer, or adrenal hyperplasia. Increased concentrations of DHEAS are not diagnostic of a specific condition; they usually indicate the need for further testing to pinpoint the cause of the hormone imbalance.
Is there anything else I should know?
DHEAS concentrations are normally high in both male and female newborns. They drop sharply shortly after birth, then rise again during puberty. DHEAS concentrations peak between the ages of 18 to 30 years and then slowly decline with age.
People taking DHEA supplements will have elevated blood concentrations of DHEAS.
Why doesn't my sample for a DHEAS level have to be taken in the morning?
DHEAS concentrations are stable and not affected by time of day, meals or activity so your sample may be collected any time of day.
Does everyone with elevated DHEAS have symptoms?
Not necessarily. It may be difficult to determine when adult men have elevated concentrations of DHEAS (since they already have masculine secondary sexual characteristics) and women of some ethnic groups (for example Asian women) may have elevated concentrations of testosterone and DHEAS without exhibiting symptoms such as excess hair growth or acne. Also, it should be noted that the symptoms present, and their severity, will vary from person to person.