DHEA sulfate (DHEA-S) is the principal adrenal androgen and is secreted together with cortisol under the control of ACTH and prolactin. DHEA-S is elevated with hyperprolactinemia. Elevated levels may be found in the adrenogenital syndrome or adrenocortical neoplasms or hyperplasias. In females, DHEA excess causes masculinization. Persistent inability to ovulate, the polycystic ovary or Stein-Leventhal syndrome is characterized by increases of circulating levels of testosterone, androstenedione, dehydroepiandrosterone and DHEA-S. 17-hydroxyprogesterone and DHEA-S are only mildly increased compared to cases of adrenal hyperplasia. Testosterone is derived from ovaries, adrenals, and the peripheral tissues. Increased DHEA with normal testosterone provides evidence for an adrenal cause of excessive androgen.
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