Serum dehydroepiandrosterone sulfate in assessing the integrity of the hypothalamic-pituitary-adrenal axis
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OBJECTIVE: To evaluate the relationship between age- and gender-adjusted dehydroepiandrosterone sulfate (DHEA-S) levels and low-dose adrenocorticotropic hormone (ACTH) stimulation in assessing the integrity of the hypothalamic-pituitary-adrenal (HPA) axis, in patients who were at risk of HPA insufficiency, including those currently being treated with glucocorticoids. METHODS: Forty-six participants with a suspicion of secondary adrenal insufficiency were recruited from the Diabetes and Endocrinology Clinic at Ramathibodi Hospital, Mahidol University, Bangkok. Low-dose (1 μg) ACTH stimulation was performed in every participants, and serum DHEA-S was measured at baseline before ACTH injection. RESULTS: Individuals with normal age- and gender-specific DHEA-S levels had baseline serum cortisol and peak cortisol levels higher than those with reduced DHEA-S. Normal age- and gender-specific DHEA-S levels predicted intact HPA function with a sensitivity of 87.1%, a specificity of 86.7%, a positive predictive value of 93.1%, and a negative predictive value of 76.5%. To account for the age and gender dependency of DHEA-S, the DHEA-S ratio was calculated by measured DHEA-S divided by the lower limit of the respective reference range for all participants. A DHEA-S ratio of more than 1.78 had 100% sensitivity regarding intact HPA function. Area under the receiver operating characteristic [ROC] curve was 0.920. (95% CI, 0.844-0.997). CONCLUSION: Normal age- and gender-specific DHEA-S level or a DHEA-S ratio of more than 1.78 are valuable markers of HPA integrity. Serum DHEA-S may be a candidate for a less costly approach where ACTH stimulation is unavailable.
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Concomitant measurement of baseline DHEAS was reported to have a good diagnostic accuracy in making a diagnosis of secondary adrenal insufficiency, including those with glucocorticoid-induced adrenal insufficiency.
“Concomitant measurement of baseline DHEAS was reported to have a good diagnostic accuracy in making a diagnosis of secondary adrenal insufficiency, including those with glucocorticoid-induced adrenal insufficiency (96, 97).”
From European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency (2024) · cites this paper as [96]
The Results report good accuracy for baseline DHEA-S in predicting HPA-axis status, and the Discussion says it was useful in both steroid users and non-users. However, the glucocorticoid-exposed participants were evaluated for suspected insufficiency; the paper does not establish diagnostic accuracy specifically among patients with confirmed glucocorticoid-induced adrenal insufficiency. (LLM, conf=0.82)
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References 23 · Cited by 37
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- Authors
- Charoensri, S., Chailurkit, L., Muntham, D., & Bunnag, P.
- Affiliations
- Mahidol University (TH)
- Rajamangala University of Technology Suvarnabhumi (TH)
- Corresponding author
- Charoensri, Suranut
- Venue
- Journal of Clinical & Translational Endocrinology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 7
- Pages
- 42-46
- ISSN
- 2214-6237 (ISSN-L)
- PMC
- PMC5651301
- OpenAlex
- W2585881425
- Cited by
- 37
- References
- 23
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 9 · 2023: 1 · 2022: 6 · 2021: 7 · 2020: 5 · 2019: 3 · 2018: 1
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical & Translational Endocrinology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Mahidol University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- dehydroepiandrosterone sulfate, hypothalamic-pituitary-adrenal axis, secondary adrenal insufficiency, low-dose ACTH stimulation test, cortisol, glucocorticoid therapy, diagnostic biomarkers
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