Sign in →

Test Code DHEAA / DHEA-M Dehydroepiandrosterone (DHEA), Serum

Additional Codes

Software Test Code
SoftID DHEAA
EPIC LAB522
Mayo Laboratories DHEA

Reporting Name

Dehydroepiandrosterone, S

Useful For

Diagnosing and differential diagnosis of hyperandrogenism (in conjunction with measurements of other sex steroids)

 

As an initial screen in adults with bioavailable testosterone measurement. Depending on results, this may be supplemented with measurements of sex hormone-binding globulin and occasionally other androgenic steroids (eg, 17-hydroxyprogesterone).

 

An adjunct in the diagnosis of congenital adrenal hyperplasia (CAH); DHEA/DHEAS measurements play a secondary role to the measurements of cortisol/cortisone, 17 alpha-hydroxyprogesterone, and androstenedione

 

Diagnosing and differential diagnosis of premature adrenarche

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum Red


Necessary Information


Patient's age and sex are required.



Specimen Required


Collection Container/Tube: Red top (serum gel/SST are not acceptable)

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Red Frozen (preferred) 28 days
  Refrigerated  21 days
  Ambient  6 hours

Special Instructions

Reference Values

Premature: <40 ng/mL*

0-1 day: <11 ng/mL*

2-6 days: <8.7 ng/mL*

7 days-1 month: <5.8 ng/mL*

>1-23 months: <2.9 ng/mL*

2-5 years: <2.3 ng/mL

6-10 years: <3.4 ng/mL

11-14 years: <5.0 ng/mL

15-18 years: <6.6 ng/mL

19-30 years: <13 ng/mL

31-40 years: <10 ng/mL

41-50 years: <8.0 ng/mL

51-60 years: <6.0 ng/mL

≥61 years: <5.0 ng/mL

 

*Source: Dehydroepiandrosterone. In: Soldin SJ, Brugnara C, Wong Ed, eds. Pediatric Reference Ranges. 5th ed. AACC Press; 2005:75

 

For SI unit Reference Values, see https://www.mayocliniclabs.com/order-tests/si-unit-conversion.html

Day(s) Performed

Monday, Thursday

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

82626

LOINC Code Information

Test ID Test Order Name Order LOINC Value
DHEA_ Dehydroepiandrosterone, S 2193-1

 

Result ID Test Result Name Result LOINC Value
81405 Dehydroepiandrosterone, S 2193-1

Clinical Information

Dehydroepiandrosterone (DHEA) is the principal human C-19 steroid. DHEA has very low androgenic potency but serves as the major direct or indirect precursor for most sex steroids. DHEA is secreted by the adrenal gland and production is at least partly controlled by adrenocorticotropic hormone (ACTH). The bulk of DHEA is secreted as a 3-sulfoconjugate dehydroepiandrosterone sulfate (DHEAS). Both hormones are albumin bound, but DHEAS binding is much tighter. As a result, circulating concentrations of DHEAS are much higher (>100-fold) compared to DHEA. In most clinical situations, DHEA and DHEAS results can be used interchangeably. In gonads and several other tissues, most notably skin, steroid sulfatases can convert DHEAS back to DHEA, which can then be metabolized to stronger androgens and to estrogens.

 

During pregnancy, DHEA/DHEAS and their 16-hydroxylated metabolites are secreted by the fetal adrenal gland in large quantities. They serve as precursors for placental production of the dominant pregnancy estrogen, estriol. Within weeks after birth, DHEA/DHEAS levels fall by 80% or more and remain low until the onset of adrenarche at age 7 or 8 in girls and age 8 or 9 in boys. Adrenarche is a poorly understood phenomenon, peculiar to higher primates, that is characterized by a gradual rise in adrenal androgen production. It precedes puberty but is not casually linked to it. Early adrenarche is not associated with early puberty or with any reduction in final height or overt androgenization. However, girls with early adrenarche may be at increased risk of polycystic ovarian syndrome as adults and some boys may develop early penile enlargement.

 

Following adrenarche, DHEA/DHEAS levels increase until the age of 20 to a maximum roughly comparable to that observed at birth. Levels then decline over the next 40 to 60 years to around 20% of peak levels. The clinical significance of this age-related drop is unknown, and trials of DHEA/DHEAS replacement in older individuals have not produced convincing benefits. However, in younger and older patients with primary adrenal failure, the addition of DHEA/DHEAS to corticosteroid replacement has been shown in some studies to improve mood, energy, and sex drive.

 

Elevated DHEA/DHEAS levels can cause signs or symptoms of hyperandrogenism in women. Men are usually asymptomatic but, through peripheral conversion of androgens to estrogens, can occasionally experience mild estrogen excess. Most mild-to-moderate elevations in DHEAS levels are idiopathic. However, pronounced elevations of DHEA/DHEAS may be indicative of androgen-producing adrenal tumors. In small children, congenital adrenal hyperplasia (CAH) due to 3 beta-hydroxysteroid dehydrogenase deficiency is associated with excessive DHEA/DHEAS production. Lesser elevations may be observed in 21-hydroxylase deficiency (the most common form of CAH) and 11 beta-hydroxylase deficiency. By contrast, steroidogenic acute regulatory protein (STAR) or 17 alpha-hydroxylase deficiency is characterized by low DHEA/DHEAS levels.

 

See Steroid Pathways in Special Instructions.

Cautions

Currently the correlation of serum dehydroepiandrosterone (DHEA)/dehydroepiandrosterone sulfate (DHEAS) level with human well-being or disease risk factors have not been completely established.

 

There are currently no established guidelines for DHEA/DHEAS replacement/supplementation therapy or its biochemical monitoring. In most settings, the value of DHEA/DHEAS therapy is doubtful. However, if DHEAS therapy is used, then it seems prudent to avoid overtreatment, with its associated hyperandrogenic effects. These are particularly likely to occur in postmenopausal females if DHEA/DHEAS levels approach or exceed the upper reference range. Most supplements contain DHEA, but the in vivo conversion to DHEAS allows monitoring of either DHEA or DHEAS.

Method Description

Deuterated stable isotope d2 dehydroepiandrosterone (d2-DHEA) is added to a 0.4 mL serum sample as internal standard. The DHEA and internal standard are extracted from the sample by solid-phase extraction. This is followed by conventional liquid chromatography on a Cohesive LX4 System and analysis on a tandem mass spectrometer equipped with a heated nebulizer ion source.(Soldin OP, Guo T, Weiderpass E, Tractenberg RE, Hilakivi-Clarke L, Soldin SJ: Steroid hormone levels in pregnancy and 1 year postpartum using isotope dilution tandem mass spectrometry. Fertil Steril. 2005 Sep:84[3]:701-710; Soeborg T, Frederiksen H, Fruekilde P, Johannsen TH, Juul A, Andersson AM: Serum concentrations of DHEA, DHEAS, 17a-hydroxyprogesterone, d4-androstenedione and testosterone in children determined by TurboFlow-LC-MS/MS. Clin Chim Acta. 2013 Apr 18;419:95-101. doi: 10.1016/j.cca.2013.01.019)

Report Available

2 to 6 days

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus OK

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Portions of this test are covered by patents held by Quest Diagnostics

Secondary ID

81405

Testing Algorithm

See Steroid Pathways in Special Instructions.