Adrenal androgen excess in hyperandrogenism: relation to age and body mass

Objective: To determine whether DHEAS levels in hyperandrogenic (HA) women retain the normal age-related decrease. Design: Prospective study. Setting: Academic tertiary care medical center. Patient(s): One hundred forty-five HA patients with hirsutism and/or oligo-ovulation and 53 healthy women. Intervention(s): Blood samples were obtained on days 3–8 of the menstrual cycle or after an IM progesterone–induced withdrawal bleed. Main Outcome Measure(s): Serum samples were assayed for progesterone, total testosterone, sex hormone-binding globulin, free testosterone, and DHEAS. Result(s): Controls and HA patients were similar in body mass index and age. A negative correlation between DHEAS levels and age, but not body mass index, was found among controls. In HA patients, DHEAS levels decreased with age. Dehydroepiandrosterone sulfate levels correlated with the hirsutism score in HA patients. When HA patients were subdivided into those with low, middle, and high DHEAS levels, those with low DHEAS levels were older and weighed more than those with high DHEAS levels. Conclusion(s): The negative association between DHEAS levels and age is preserved in HA women. Hyperandrogenic patients with high DHEAS levels are younger, thinner, and more hirsute than those with lower DHEAS levels. These findings suggest that the diagnosis of adrenal androgen excess in HA patients may require the use of age-adjusted normative values.