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23122 Dehydroepiandrosterone (DHEA_)

Dehydroepiandrosterone (DHEA_)
Test Code: DANDRSO
Synonyms/Keywords
DHEA (Dehydroepiandrosterone) Unconjugated, DHEA(S), DHEA, Unconjugated
Useful For
​Diagnosing and differential diagnosis of hyperandrogenism (in conjunction with measurements of other sex steroids)
 
An initial screen in adults might include dehydroepiandrosterone/dehydroepiandrosterone sulfate and 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; dehydroepiandrosterone/dehydroepiandrosterone sulfate measurements play a secondary role to the measurements of cortisol/cortisone, 17 alpha-hydroxyprogesterone, and androstenedione.
 
Diagnosing and differential diagnosis of premature adrenarche
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ 1 mL​ 0.5 mL​
Collection Processing Instructions

​Submit sample in plastic vial.

Patient's age and sex are required.

Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Frozen (preferred)​ 28 days​
Refrigerated ​ 21 days​
​Ambient ​6 hours
Rejection Criteria
Gross hemolysis
​Gross lipemia
Interference

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.

Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
​Mayo Clinic Laboratories Monday, Thursday
2 to 6 days​
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)​
Reference Lab
Reference Range Information

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

> or =61 years: <5.0 ng/mL

Interpretation
Elevated dehydroepiandrosterone (DHEA)/ dehydroepiandrosterone sulfate (DHEAS) levels indicate increased adrenal androgen production. Mild elevations in adults are usually idiopathic, but levels >5-fold or more of the upper limit of normal can suggest the presence of an androgen-secreting adrenal tumor. DHEA/DHEAS levels are elevated in >90% of patients with such tumors. This is particularly true for androgen-secreting adrenal carcinomas, as they have typically lost the ability to produce downstream androgens, such as testosterone. By contrast, androgen-secreting adrenal adenomas may also produce excess testosterone and secrete lesser amounts of DHEA/DHEAS.
 
Patients with congenital adrenal hyperplasia (CAH) may show very high levels of DHEA/DHEAS, often 5-fold to 10-fold elevations. However, with the possible exception of 3 beta-hydroxysteroid dehydrogenase deficiency, other steroid analytes offer better diagnostic accuracy than DHEA/DHEAS measurements. Consequently, DHEA/DHEAS testing should not be used as the primary tool for CAH diagnosis. Similarly, discovering a high DHEA/DHEAS level in an infant or child with symptoms or signs of possible CAH should prompt additional testing, as should the discovery of very high DHEA/DHEAS levels in an adult. In the latter case, adrenal tumors need to be excluded and additional adrenal steroid profile testing may assist in diagnosing nonclassical CAH.
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​82626
Synonyms/Keywords
DHEA (Dehydroepiandrosterone) Unconjugated, DHEA(S), DHEA, Unconjugated
Ordering Applications
Ordering Application Description
​Centricity ​DHEA, S (81405)
​Cerner ​DHEA
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ 1 mL​ 0.5 mL​
Collection Processing

​Submit sample in plastic vial.

Patient's age and sex are required.

Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Frozen (preferred)​ 28 days​
Refrigerated ​ 21 days​
​Ambient ​6 hours
Rejection Criteria
Gross hemolysis
​Gross lipemia
Interference

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.

Useful For
​Diagnosing and differential diagnosis of hyperandrogenism (in conjunction with measurements of other sex steroids)
 
An initial screen in adults might include dehydroepiandrosterone/dehydroepiandrosterone sulfate and 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; dehydroepiandrosterone/dehydroepiandrosterone sulfate measurements play a secondary role to the measurements of cortisol/cortisone, 17 alpha-hydroxyprogesterone, and androstenedione.
 
Diagnosing and differential diagnosis of premature adrenarche
Reference Range Information

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

> or =61 years: <5.0 ng/mL

Interpretation
Elevated dehydroepiandrosterone (DHEA)/ dehydroepiandrosterone sulfate (DHEAS) levels indicate increased adrenal androgen production. Mild elevations in adults are usually idiopathic, but levels >5-fold or more of the upper limit of normal can suggest the presence of an androgen-secreting adrenal tumor. DHEA/DHEAS levels are elevated in >90% of patients with such tumors. This is particularly true for androgen-secreting adrenal carcinomas, as they have typically lost the ability to produce downstream androgens, such as testosterone. By contrast, androgen-secreting adrenal adenomas may also produce excess testosterone and secrete lesser amounts of DHEA/DHEAS.
 
Patients with congenital adrenal hyperplasia (CAH) may show very high levels of DHEA/DHEAS, often 5-fold to 10-fold elevations. However, with the possible exception of 3 beta-hydroxysteroid dehydrogenase deficiency, other steroid analytes offer better diagnostic accuracy than DHEA/DHEAS measurements. Consequently, DHEA/DHEAS testing should not be used as the primary tool for CAH diagnosis. Similarly, discovering a high DHEA/DHEAS level in an infant or child with symptoms or signs of possible CAH should prompt additional testing, as should the discovery of very high DHEA/DHEAS levels in an adult. In the latter case, adrenal tumors need to be excluded and additional adrenal steroid profile testing may assist in diagnosing nonclassical CAH.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
​Mayo Clinic Laboratories Monday, Thursday
2 to 6 days​
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)​
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​82626
For most current information refer to the Marshfield Laboratory online reference manual.