DHEA(S)—a novel marker in Cushing’s disease

• Published in: Acta neurochirurgica Vol. 155; no. 3; pp. 479 - 484
• Main Authors: Burkhardt, T., Schmidt, N. O., Vettorazzi, E., Aberle, J., Mengel, M., Flitsch, J.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.03.2013; Springer Nature B.V
• Subjects: Adenoma - blood; Adenoma - diagnosis; Adenoma - surgery; Adolescent; Adrenocorticotropic hormone; Adrenocorticotropic Hormone - blood; Adult; Aged; Biomarkers, Tumor - blood; Blood levels; Bone turnover; Child; Clinical Article - Brain Tumors; Dehydroepiandrosterone sulfate; Dehydroepiandrosterone Sulfate - blood; Diabetes mellitus; Female; Humans; Hydrocortisone; Hydrocortisone - blood; Hypothalamic-pituitary-adrenal axis; Interventional Radiology; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Nervous system diseases; Neurology; Neuroprotection; Neuroradiology; Neurosurgery; Obesity; Pituitary; Pituitary ACTH Hypersecretion - blood; Pituitary ACTH Hypersecretion - diagnosis; Pituitary ACTH Hypersecretion - surgery; Pituitary Neoplasms - blood; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - surgery; Postoperative Complications - blood; Predictive Value of Tests; Reference Values; Standard deviation; Steroid hormones; Surgery; Surgical Orthopedics; Young Adult; DHEA(S); Perioperative; Marker; Cushing’s disease
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-012-1596-6

Introduction Dehydroepiandrosterone sulfate (DHEA(S)) is a multi-functional steroid implicated in a broad range of biological effects, including obesity, diabetes, bone metabolism, neuroprotection, and anti-tumorigenesis. It has not yet undergone wider research in the context of Cushing’s disease. The objective of this study was to determine if perioperative blood levels of DHEA(S) correlate with levels of ACTH and cortisol, and therefore may be useful as a new, additional marker for the early definition of cure in patients suffering from Cushing’s disease. Methods Forty-two consecutive patients undergoing transsphenoidal surgery for Cushing’s disease from September 2009 to September 2010 were perioperatively monitored for ACTH, cortisol, and DHEA(S). Results Pre-operative blood samples revealed ACTH levels of median 65 ng/l (range 11–1,183 ng/l, standard deviation 183.76), cortisol of median 257 μg/l (range 93–803 μg/l, standard deviation 140.88), and DHEA(S) of median 2.22 mg/l (range 0.44–7.79 mg/l, standard deviation 1.82) according to the pathology of Cushing’s disease. Postoperative blood samples drawn over a 7-day time span showed a drop in median ACTH to just 14.5 % (median: 9 ng/l, range 2–44, standard deviation 12.75) of its median preoperative figure. Median cortisol levels were reduced to 6.9 % (median: 18 μg/l, range 10–190 μg/l, standard deviation 38.04) of their preoperative values and DHEA(S) levels decreased to 17 % (median: 0.38 mg/l, range 0.05–2.29, standard deviation 0.51). In persistent disease, no patient showed a drop in DHEA(S) below 38 % of its preoperative figures. Conclusions DHEA(S) shows the potential to become an additional marker in the diagnosis and follow-up of patients. However, it needs to be examined further, including whether DHEA(S) may also be a useful predictor of recovery of the HPA-axis after successful surgery.