Evaluation Of Dheas (Dehydroepiandrosterone Sulfate) Levels In Patients With Adrenal Adenomas Exhibiting Autonomous Cortisol Secretion.

BACKGROUND

Autonomous cortisol secretion (ACS) is the most common hormonal dysfunction in adrenal incidentalomas and is associated with increased cardiometabolic morbidity. Dehydroepiandrosterone sulfate (DHEAS), an ACTH-dependent adrenal steroid, may decrease in ACS due to hypothalamic-pituitary-adrenal axis suppression. This study evaluated the diagnostic utility of DHEAS and DHEAS-based ratios, particularly within a dexamethasone suppression test (DST)-integrated framework, for differentiating ACS from non-functioning adrenal adenomas (NFA).

METHODS

In this retrospective single-center study, records of 433 patients followed for adrenal incidentaloma between 2015 and 2021 were reviewed. After applying predefined criteria, 67 patients were included: 35 with ACS and 32 with NFA. ACS was defined using a post-1 mg DST cortisol threshold of ≥ 1.8 µg/dL and confirmed with a two-day low-dose DST. Clinical, metabolic, biochemical, hormonal, and radiological parameters were analyzed. ROC analyses and logistic regression were performed, and internal validation was conducted using bootstrapping with 1,000 iterations.

RESULTS

Comorbidities were more frequent in ACS. ACTH, DHEAS, DHEAS/cortisol ratio, DHEAS/1-mg DST cortisol ratio, and TyG index differed significantly between groups. Post-1 mg DST cortisol showed the highest discriminatory performance (AUC = 0.967). Although DHEAS alone had limited diagnostic utility, the DHEAS/1-mg DST cortisol ratio showed good discrimination (AUC = 0.884, 95% CI: 0.802-0.966) and remained the only independent predictor of ACS (OR: 0.931, 95% CI: 0.895-0.968, p < 0.001). TyG showed moderate discrimination but was not an independent predictor.

CONCLUSION

The DHEAS/1-mg DST cortisol ratio may serve as a useful adjunctive marker for ACS-NFA differentiation, especially in borderline or ambiguous cases, but requires prospective external validation.