Language
English
Publication Date
8-7-2025
Journal
The Journal of Clinical Endocrinology & Metabolism
DOI
10.1210/clinem/dgae855
PMID
39657727
Abstract
Context: Diagnosing adrenal insufficiency (AI) often requires complex testing, which can be time-consuming and expensive. Dehydroepiandrosterone sulfate (DHEAS) is a promising marker of hypothalamic-pituitary-adrenal axis function; however, its diagnostic performance has not yet been evaluated in a large-scale study.
Objective: Evaluate the performance of DHEAS and baseline cortisol in assessing AI.
Design: Single-center retrospective cohort study.
Setting: Referral center.
Patients: Adults who underwent cosyntropin stimulation testing (CST) between 2005 and 2023 and had DHEAS measured within 3 months prior to CST.
Main outcome measures: Area under receiver operating characteristic curve (AUROC) for DHEAS and baseline cortisol. Prevalence of AI based on various DHEAS and baseline cortisol concentrations.
Results: Among 1135 patients, 195 (17.2%) had AI. Both baseline cortisol and DHEAS independently had good diagnostic performance with AUROC 0.81 [95% confidence interval (CI) 0.77-0.84 and 0.81 (95% CI 0.78-0.85)], respectively. Time of CST performance had no significant effect on diagnostic accuracy of baseline cortisol while recent glucocorticoid use decreased diagnostic performance of DHEAS (AUROC 0.72 vs 0.83). Only 1.2% of patients with baseline cortisol ≥10 mcg/dL had AI based on CST. Among patients with baseline cortisol between 5 and 9.9 mcg/dL, only 1.3% had AI if DHEAS was ≥60 mcg/dL. Conversely, the majority (72.2%) of patients with both baseline cortisol < 5 mcg/dL and DHEAS < 25 mcg/dL were found to have AI.
Conclusion: DHEAS has good diagnostic performance in assessing AI. Measuring both baseline cortisol and DHEAS concentrations may eliminate the need for further dynamic testing in many patients.
Keywords
Humans, Dehydroepiandrosterone Sulfate, Adrenal Insufficiency, Hydrocortisone, Male, Female, Retrospective Studies, Middle Aged, Adult, Aged, Biomarkers, Cosyntropin, ROC Curve, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, CST, DHEAS, cortisol, cosyntropin, diagnosis, stimulation test, synacthen
Published Open-Access
yes
Recommended Citation
Han, Ashley J; Suresh, Malavika; Gruber, Lucinda M; et al., "Performance of Dehydroepiandrosterone Sulfate and Baseline Cortisol in Assessing Adrenal Insufficiency" (2025). Faculty, Staff and Students Publications. 8411.
https://digitalcommons.library.tmc.edu/baylor_docs/8411