Dehydroepiandrosterone replacement for patients with adrenal insufficiency

• Published in: The Lancet (British edition) Vol. 357; no. 9266; pp. 1381 - 1382
• Main Authors: Achermann, John C, Silverman, Bernard L
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 05.05.2001; Lancet; Elsevier Limited
• Subjects: Addison Disease - drug therapy; Adjuvants, Immunologic - metabolism; Adjuvants, Immunologic - therapeutic use; Adrenal glands; Adult; Aged; Aging - metabolism; Biological and medical sciences; Dehydroepiandrosterone - metabolism; Dehydroepiandrosterone - therapeutic use; Female; Hormones. Endocrine system; Humans; Male; Medical research; Medical sciences; Middle Aged; Patients; Pharmacology. Drug treatments; Randomized Controlled Trials as Topic; Self Concept; Steroids; Endocrinopathy; Human; Replacement therapy; Androgen; Fatigue; Chemotherapy; Dehydroepiandrosterone; Mood; Adrenal insufficiency; Adrenal gland diseases; Sex steroid hormone; Elderly; Sexual function; Geriatrics
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(00)04617-1

Circulating DHEA/DHEA-S concentrations show characteristic changes with age. DHEA/DHEA-S are the principal steroids released by the human fetal adrenal gland and concentrations fall during infancy as the fetal zone of the adrenal involutes. However, concentrations of DHEA/DHEA-S rise again in mid-childhood as the zona reticularis matures ("adrenarche"), and reach a peak at 20-30 years of age.2 At this time, DHEA-S concentrations are approximately 20 times greater than those of cortisol because of increased secretion and decreased clearance of DHEA-S, and conversion of DHEA to DHEA-S in the adrenal and liver. Thereafter, a steady decline in DHEA/DHEA-S occurs with age, such that by age 70 circulating concentrations are only 20-30% of the peak concentrations of young adulthood.2 Thus, normal elderly individuals might be deemed "deficient" in DHEA/DHEA-S.