What causes dhea to be high

What is DHEA?

Dehydroepiandrosterone (DHEA) is a hormone naturally produced by the body, primarily in the adrenal glands, which are located on top of the kidneys. It is also produced in smaller amounts by the gonads (ovaries in women and testes in men) and the brain. DHEA is considered an 'androgen precursor,' meaning it can be converted into other hormones, including testosterone and estrogen, in the body. DHEA levels typically rise during childhood, peak in early adulthood (around age 20-25), and then gradually decline with age. It plays a role in various bodily functions, including the development of secondary sexual characteristics, metabolism, and immune function.

Why Might DHEA Levels Be High?

Elevated levels of DHEA, or more commonly its sulfated form DHEA-S (dehydroepiandrosterone sulfate, which is more stable in the blood), can indicate an underlying medical condition. The most frequent culprits involve the adrenal glands, where DHEA is predominantly synthesized.

Adrenal Gland Disorders:

The adrenal glands are a common source of high DHEA. Several conditions affecting these glands can lead to overproduction:

• Congenital Adrenal Hyperplasia (CAH): This is a group of genetic disorders that affect the adrenal glands' ability to produce certain hormones, including cortisol. In many forms of CAH, there is an enzyme deficiency that leads to a buildup of precursors, including DHEA. This is a common cause of high DHEA-S in both children and adults.
• Adrenal Tumors: Both benign (adenomas) and malignant (carcinomas) tumors of the adrenal cortex can secrete excessive amounts of androgens, including DHEA. These tumors can cause symptoms related to hormone excess.
• Adrenal Hyperplasia: In some cases, non-congenital overgrowth of the adrenal cortex (adrenal hyperplasia) can lead to increased hormone production.

Polycystic Ovary Syndrome (PCOS):

PCOS is a common hormonal disorder among women of reproductive age. While the primary issue in PCOS is often related to the ovaries, the adrenal glands can also be involved. In about 20-30% of women with PCOS, there may be a mild elevation in DHEA-S, contributing to symptoms like irregular periods, acne, and excess hair growth (hirsutism).

Other Less Common Causes:

• Cushing's Syndrome: While primarily characterized by excess cortisol, some forms of Cushing's syndrome, especially those caused by adrenal tumors, can also involve the overproduction of other adrenal hormones like DHEA.
• Genetic Disorders: Rare genetic conditions can sometimes affect hormone production pathways, leading to elevated DHEA.
• Premature Puberty: In children, high DHEA levels can sometimes be a sign that puberty is starting earlier than normal.

Symptoms Associated with High DHEA

The symptoms of high DHEA depend heavily on the underlying cause and the individual's age and sex. In women and children, symptoms often relate to androgen excess:

• Hirsutism (excessive hair growth on the face, chest, or back)
• Acne
• Male-pattern baldness
• Deepening of the voice
• Clitoral enlargement
• Irregular menstrual cycles
• Early development of pubic hair and secondary sexual characteristics (in children)

In men, symptoms of high DHEA are less common, as the body can often convert excess androgens into other hormones. However, very high levels might contribute to aggressive behavior or premature balding.

Diagnosis and Testing

If high DHEA levels are suspected, a doctor will typically order blood tests to measure DHEA-S. Because DHEA-S is more stable, it's the preferred marker for assessing adrenal androgen production. The test is usually done in the morning. Depending on the results and symptoms, further investigations may be needed, such as:

• Imaging tests (CT scan or MRI) of the adrenal glands or ovaries to look for tumors or structural abnormalities.
• Other hormone level tests to assess the balance of various hormones.
• Genetic testing for conditions like CAH.

Treatment

Treatment for high DHEA focuses on addressing the underlying cause:

• CAH: Treated with corticosteroid medications to suppress the adrenal glands' overproduction of androgens and replace the deficient cortisol.
• Adrenal Tumors: Treatment depends on whether the tumor is benign or malignant. Benign tumors might be monitored or surgically removed. Malignant tumors require more aggressive treatment, potentially including surgery, chemotherapy, or radiation.
• PCOS: Management typically involves lifestyle changes (diet, exercise), hormonal birth control pills, and medications to improve insulin sensitivity.

It's crucial to consult a healthcare professional for proper diagnosis and management if you suspect you have high DHEA levels. Self-diagnosing or self-treating can be dangerous.