Biochemical Diagnosis of Adrenal Insufficiency: the Added Value of Dehydroepiandrosterone Sulfate Measurements

Al-Aridi, Ribal; Abdelmannan, Dima; Arafah, Baha M.

doi:10.4158/ep10262.ra

Cited by 40 publications

(27 citation statements)

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“…[16] However; DHEA-S if not enough for diagnosis, and low values need to be confirmed by other tests for adrenal function. [5] DHEA-S could not differentiate between primary or secondary adrenal failure and low DHEA-S also found after post-traumatic stress disorder and depressive symptoms. [21] The worst performance was plasma ACTH in this study.…”

Section: Discussionmentioning

confidence: 70%

“…This finding is not explored before. [5] The potential application of this study is that DHEA-S used as a tool to diagnose hypothalamic pituitary adrenal dysfunction in the afternoon because DHEA-S not subjected to circadian rhythm due to prolonged half-life. [11,20,21,[26][27][28] Since the majority of HPAD will present at afternoon to the emergency units or hospitals were the short cosyntropin not feasible and serum cortisol, and plasma ACTH will become unreliable.…”

Section: Discussionmentioning

confidence: 99%

“…Others advocate that serum cortisol ≤ 5μg/dL to confirm HPAD. [5,[10][11]19] In children some suggested that un-stimulated serum cortisol <3.9μg/dL is mandatory for the diagnosis of HPAD, if used alone with morning cortisol >13.8 µg/dl goes with normal function and they advised doing dynamic stimulation tests only for those with morning cortisol between 3.9-13.8 µg/dl. [20] The performance of DHEA-S was medium in between.…”

Section: Discussionmentioning

confidence: 99%

“…This was esta-blished recommendation by some endocrinologist. [5] The use of three panels of tests involving serum cortisol, serumDHEA-S, and plasma ACTH will have the best specificity, but very poor sensitivity. This finding is not explored before.…”

Section: Discussionmentioning

confidence: 99%

“…Serum cortisol level below 1.8 µ/dl or above 18 µ/dl confirm and exclude AI respectively. [5] Adrenal androgens androstenedione,dehydroepi androsterone and dehydroepiandrosterone sulphate (DHEA-S) in particular DHEA-S less affected by circadian rhythm and has a long half-life reach 10-20 hours. [6] Normal age and sex specific DHEA-S has sensitivity of 100 % to exclude HPAD.…”

mentioning

confidence: 99%

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The performance of serum cortisol, plasma corticotropin and serum dehydroepiandrosterone sulfate levels in the diagnosis of hypothalamic pituitary adrenal dysfunction

Alhamza¹,

Mansour²,

Haddad³

2015

Int Arch Med

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Background: There is no single test can identify hypothalamic-pituitary-adrenal dysfunction (HPAD) perfectly. The study aimed to assess the performance of measuring serum cortisol, serum dehydroepiandrosterone sulfate (DHEA-S) and plasma corticotropin (ACTH) in comparison with standard-dose short cosyntropin (250 µg) testing for the diagnosis of HPAD.Methods: This is a cross-sectional study from Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basrah for the period of November 2014 to October 2015. For all patients with suspected HPAD; baseline serum cortisol, serum DHEA-S and plasma ACTH and were measured, followed by a formal short cosyntropin test as the gold standard test. Results:The total number of the study participant was 169 patients.Of them, 134 (79.3%) were women. Their age ranges from 5-80 years. The cut-off serum cortisol that predicts abnormal short cosyntropin test was less than 5.31 µg/dl with maximal sensitivity and specificity of 87.7% and 90.4% respectively. The cut-off serum DHEA-S that predict abnormal short cosyntropin test was less than 31.11 µg/dl with a sensitivity of 89.2%and specificity of 62.7%. The least reliable parameter to predict the abnormal short cosyntropin was the plasma ACTH level with a cut-off of less than 5.30 pg/ml and lowest sensitivity of 68.8% and specificity of 74.5%. Conclusion:To exclude HPAD, serum cortisol at 9-11 am having the highest predictive value, DHEA-S has the midway function and plasma

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Section: Discussionmentioning

confidence: 70%