What could be the cause of persistently high DHEA-S levels and hair Loss in a young woman?

Welcome to icliniq.com.

I can understand your concern.

Elevated DHEAS (dehydroepiandrosterone sulfate) levels can cause signs or symptoms of hyperandrogenism in women. High levels may be due to PCOS, congenital adrenal hyperplasia, insulin, stress, elevated prolactin, alcohol, and certain medications like ADHD medications, Xanax and Wellbutrin.

Most mild-to-moderate elevations in DHEAS levels are of unknown origin. However, pronounced elevations of DHEA/DHEAS like what she has now of over 2000 may be indicative of androgen-producing adrenal tumors or congenital adrenal hyperplasia (CAH). In small children, congenital adrenal hyperplasia 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.

Origins of lower elevations of DHEA and DHEA-s include the following:

1. Chronic daily stress

2. PTSD (post-traumatic stress disorder)

3. PCOS (polycystic ovary syndrome)

4. Elevated prolactin

5. Non-classical adrenal hyperplasia

Symptoms of elevated DHEA include:

High DHEA can cause symptoms of androgen excess including oily skin, acne, sleep problems, headaches, and mood disturbances. In some cases, highly androgenic people may show high levels of both DHEA and testosterone without negative clinical consequences.

Symptoms are as follows:

1. Difficulty in controlling weight

2. Acne or oily skin

3. Excess hair growth all over the body (hirsutism).

4. Male patterned baldness

5. Generalized fatigue or low energy

6. Irritability, anger, or depression (and other changes in mood)

7. Infertility

8. Changes in your voice (a deeper voice in women)

9. Changes in muscle structure (increase in muscle mass)

10. Aggressive behavior

11. Reduction in breast size

12. Known history of PCOS

13. Recent history of stress

Management of elevated DHEA includes the following steps:

High DHEA can be managed with a blood sugar-balancing lifestyle and stress reduction. You told me that she had already investigated and no congenital issues were found. So I think it is better to do a magnetic resonance imaging (MRI) as planned and repeat the tests, especially DHEAS (dehydroepiandrosterone sulfate),17 OH (17-hydroxyprogesterone), and androstenedione. It looks like it is due to PCOS

I hope this helps. Feel free to contact me if you have any further queries.

Thank you.

Welcome back to icliniq.com

I understand how frustrating it would be for the family when a younger child has issues like this. It is worth investigating the adrenal tumor in this case. I will give you some basic points about adrenals and the types of tumors they can have.

Each person has two adrenal glands. One is on top of each kidney. The body has two kidneys. The adrenal glands are small, yellowish in color, and normally weigh about 0.35 ounces. These glands are important to the body’s endocrine system. The endocrine system is made up of tissues and organs that produce hormones. Hormones are chemical substances that are carried through the bloodstream to have a specific effect on the activity of other organs or cells in the body.

Each adrenal gland has two main parts that function separately:

1. Adrenal cortex: The outer part of the adrenal gland is called the cortex. The adrenal cortex makes 3 main hormones: cortisol, aldosterone, and dehydroepiandrosterone (DHEA). These hormones carefully control metabolism, blood pressure, and body features, such as hair growth and body shape.

2. Adrenal medulla. The inner part of the adrenal glands is called the medulla. The adrenal medulla makes three hormones namely epinephrine, norepinephrine, and dopamine. These hormones, often called catecholamines, control the body’s responses to stress, including the “fight or flight” adrenaline surge. Now coming to adrenal tumors.

Primary adrenal gland tumors include the following:

1. Adenoma: This is the most common type of adrenal gland tumor. Adenoma is also called an adrenocortical adenoma. It is a noncancerous tumor of the adrenal cortex that can be functioning or nonfunctioning. A small adenoma that does not cause symptoms and does not produce hormones excessively often does not need treatment. Adenoma that produces hormones excessively is called aldosteronoma and it produces a blood pressure hormone called aldosterone. Adenoma that produces too much cortisol results in a syndrome called Cushing's syndrome, which is characterized by weight gain, easy bruising, high blood pressure, and diabetes.

1. Adrenocortical carcinoma: Adrenocortical carcinoma begins in the adrenal cortex. It is rare, but it is the most common type of cancerous adrenal gland tumor. Adrenocortical carcinoma is also known as adrenal cortical carcinoma. Approximately one to two people out of every one million people develop adrenocortical carcinoma. Adrenocortical carcinoma can be a functioning or nonfunctioning tumor. If the tumor is functioning, it may produce more than one hormone.

2. Neuroblastoma: This is a type of childhood cancer that can begin in the adrenal medulla.

3. Pheochromocytoma. This type of neuroendocrine tumor most often begins in the adrenal medulla and is characterized by high blood pressure, rapid heartbeat, and sweating.

We do some blood tests to check if these tumors are functional or nonfunctional and imaging and scans to check if there is any tumor and how likely it is to be cancerous or noncancerous. Usually biopsy is not needed especially if the tumor size is small.

I hope it will relieve some of your tension and I need you to follow up with the concerned endocrinologist.

Thank you.