Central Adrenal Insufficiency Could Not Be Confirmed by Measurement of Basal Serum DHEAS Levels in Pubertal Children

Abstract

Background: Central adrenal insufficiency (CAI) is due to a decrease of CRH and/or ACTH secretion. ACTH-dependent dehydroepiandrosterone sulphate (DHEAS) has been postulated as a possible marker of adrenal function in adult patients. Aims: To evaluate the usefulness of basal serum DHEAS determination to diagnose CAI in pubertal patients with a suspected diagnosis of CAI. Methods: Ninety-four pubertal patients suspected of having CAI were divided into two groups according to sufficient (group 1) or insufficient (group 2) low-dose ACTH test serum cortisol response. Concordance with low (<2.5th percentile) or normal (≥2.5th percentile) basal serum DHEAS levels for age and sex, respectively, was analysed. Results: Fifty patients (53.2%) in group 1 and 44 (46.8%) in group 2 were included. The median value of serum DHEAS levels in group 2 (0.7 µmol/l, interquartile range 0.44-1.49) was significantly lower than in group 1 (2.13 µmol/l, interquartile range 0.87-3.5; p < 0.03). Nevertheless, serum basal DHEAS levels as a diagnostic marker of CAI showed 39% sensitivity and 80% specificity. Conclusion: In pubertal patients, basal serum DHEAS levels do not seem to be a useful tool to diagnose either sufficiency or insufficiency of secondary adrenal function.

Predictor Variables of Developing Anterior Pituitary Deficiencies in a Group of Paediatric Patients with Central Diabetes Insipidus and Langerhans Cell Histiocytosis

“…The hypothalamicpituitary thyroid and adrenal axes were evaluated by determining serum basal T4, T3, fT4, and TSH, thyroid antibodies, and morning ACTH and cortisol levels, and/or the low-dose ACTH test, respectively [22] . Patients were assessed periodically at least once a year.…”

Central adrenal insufficiency: who, when, and how? From the evidence to the controversies – an exploratory review

“…Dehydroepiandrosterone sulfate (DHEAS) is exclusively produced in the adrenal reticularis zone by ACTH stimulus ( 1 , 2 ). Some studies have suggested that impairment of adrenal androgen secretion precedes glucocorticoid deficiency in patients with CAI ( 45 - 47 ). Its mechanisms are not fully understood, but some insights are presented by Topor and cols.…”

“…DHEAS has a longer half-life (about 20 h) and lesser diurnal variation than cortisol ( 47 ), which can be advantageous. These two factors provide serum levels of DHEAS all day long (unlike cortisol).…”