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Test Code Billings Clinic: 8421 Mayo: DHES1 Dehydroepiandrosterone Sulfate, Serum

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Reporting Name

Dehydroepiandrosterone Sulfate, S

Useful For

Diagnosis and differential diagnosis of hyperandrogenism (in conjunction with measurements of other sex steroids)


An adjunct in the diagnosis of congenital adrenal hyperplasia


Diagnosis and differential diagnosis of premature adrenarche

Method Name

Immunoenzymatic Assay

Specimen Required


Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 0.6 mL

Specimen Type


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  30 days

Reject Due To

Gross hemolysis Reject
Gross lipemia OK

Reference Values


1-14 days: DHEA-S levels in newborns are very elevated at birth but will fall to prepubertal levels within a few days.

Tanner Stages* 



Reference Range (mcg/dL)

Stage I

>14 days


Stage II

11.5 years


Stage III

13.6 years


Stage IV

15.1 years


Stage V

18.0 years


*Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for boys at a median age of 11.5 (±) 2 years. For boys, there is no proven relationship between puberty onset and body weight or ethnic origin. Progression through Tanner stages is variable. Tanner stage V (adult) is usually reached by age 18.

18-30 years: 105-728 mcg/dL

31-40 years: 57-522 mcg/dL

41-50 years: 34-395 mcg/dL

51-60 years: 20-299mcg/dL

61-70 years: 12-227 mcg/dL

≥71 years: 6.6-162 mcg/dL


1-14 days: DHEA-S levels in newborns are very elevated at birth but fall to prepubertal levels within a few days.

Tanner Stages* 



Reference Range (mcg/dL)

Stage I

>14 days


Stage II

10.5 years


Stage III

11.6 years


Stage IV

12.3 years


Stage V

14.5 years


*Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for girls at a median age of 10.5 (±) 2 years. There is evidence that it may occur up to 1 year earlier in obese girls and in African American girls. Progression through Tanner stages is variable. Tanner stage V (adult) is usually reached by age 18.

18-30 years: 83-377 mcg/dL

31-40 years: 45-295 mcg/dL

41-50 years: 27-240 mcg/dL

51-60 years: 16-195 mcg/dL

61-70 years: 9.7-159

≥71 years: 5.3-124 mcg/dL


Elevated dehydroepiandrosterone sulfate (DHEA-S) levels indicate increased adrenal androgen production. Mild elevations in adults are usually idiopathic, but levels of 600 mcg/dL or more can suggest the presence of an androgen-secreting adrenal tumor. DHEA-S levels are elevated in more than 90% of patients with such tumors, usually well above 600 mcg/dL. This is particularly true for androgen-secreting adrenal carcinomas, as they have typically lost the ability to produce down-stream androgens, such as testosterone. By contrast, androgen-secreting adrenal adenomas may also produce excess testosterone and secrete lesser amounts of DHEA-S.


Patients with congenital adrenal hyperplasia (CAH) may show very high levels of DHEA-S, often 5- to 10-fold elevations. However, with the possible exception of 3 beta-hydroxysteroid dehydrogenase deficiency, other steroid analytes offer better diagnostic accuracy than DHEA-S measurements. Consequently, DHEA-S testing should not be used as the primary tool for CAH diagnosis. Similarly, discovering a high DHEA-S level in an infant or child with symptoms or signs of possible CAH should prompt additional testing, as should the discovery of very high DHEA-S levels in an adult. In the latter case, adrenal tumors need to be excluded and additional adrenal steroid profile testing may assist in diagnosing nonclassical CAH.


Girls below the age of 7 to 8 and boys before age 8 to 9, who present with early development of pubic hair, or, in boys, penile enlargement, may be suffering from either premature adrenarche or premature puberty or both. Measurement of DHEA-S (DHES / Dehydroepiandrosterone Sulfate [DHEA-S], Serum), dehydroepiandrosterone (DHEA_ / Dehydroepiandrosterone [DHEA], Serum), and androstenedione (ANST / Androstenedione, Serum), alongside determination of sensitive estradiol (EEST / Estradiol, Serum), testosterone and bioavailable (TTBS / Testosterone, Total and Bioavailable, Serum), or free testosterone (TGRP / Testosterone, Total and Free, Serum), sex hormone-binding globulin (SHBG / Sex Hormone-Binding Globulin [SHBG], Serum), and luteinizing hormone (LH / Luteinizing Hormone [LH], Serum)/follicle-stimulating hormone (FSH / Follicle-Stimulating Hormone [FSH], Serum) levels will allow correct diagnosis in most cases. In premature adrenarche, only the adrenal androgens, chiefly DHEA-S, will be above prepubertal levels, whereas early puberty will also show a fall in SHBG levels and variable elevations of gonadotropins and gonadal sex-steroids above the prepuberty reference range.


Levels of DHEA-S do not show significant diurnal variation.

Many drugs and hormones can result in changes in DHEA-S levels. Whether any of these secondary changes in DHEA-S levels are of clinical significance and how they should be related to the established normal reference ranges is unknown. In most cases, the drug-induced changes are not large enough to cause diagnostic confusion, but when interpreting mild abnormalities in DHEA-S levels, drug and hormone interactions should be taken into account.


Examples of drugs and hormones that can reduce DHEA-S levels include: insulin, oral contraceptive drugs, corticosteroids, central nervous system agents that induce hepatic enzymes (eg, carbamazepine, clomipramine, imipramine, phenytoin), many antilipemic drugs (eg, statins, cholestyramine), domapinergic drugs (eg, levodopa/dopamine, bromocryptine), fish oil, and vitamin E.


Drugs that may increase DHEA-S levels include: metformin, troglitazone, prolactin, (and by indirect implication many neuroleptic drugs), danazol, calcium channel blockers (eg, diltiazem, amlodipine), and nicotine.

Day(s) and Time(s) Performed

Monday through Friday; 6 a.m.-12 a.m.

Saturday; 6 a.m.-6 p.m.

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
DHES1 Dehydroepiandrosterone Sulfate, S 2191-5


Result ID Test Result Name Result LOINC Value
DHES1 Dehydroepiandrosterone Sulfate, S 2191-5


If not ordering electronically, complete, print, and send a General Request (T239) with the specimen.