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Forum Name: Endocrinology Topics

Question: Elevated DHEA, normal abdominal CT


 csel - Mon Dec 07, 2009 2:03 am

I'm a 57 year female diagnosed with Fibromyalgia, Chronic Fatigue Syndrome and hypothyroidism (said to be secondary to a "sluggish" HPA axis due to FMS). Lab tests are normal except for an elevated LDL; DHEA and DHEA-S have been elevated at times (DHEA 676 ng/dL; normal= 69-414) and normal at other times; FSH and testosterone are normal, IGF-1 is normal, 24 hour catecholamines+VMA is normal. A CT of the abdomen shows "no evidence of adrenal neoplasm". Brain MRI is normal, thyroid ultrasound and thyroid antibodies are normal.

I continue to have panic attacks and paroxsmal atrial fibrillation (determined by holter monitor) as well as very oily skin/acne, excessive hair growth on face, fatigue and unrefreshed sleep (despite using a CPAP for sleep apnea and low dose doxepin, which stops me from multiple awakenings during the night), muscle pain and joint stiffness and a whole host of other FMS symptoms.

I am on 50 mcg Unithroid and 10mg doxepin. Various meds for Fibromyalgia and chronic pain such as Lyrica, Cymbalta, Topamax, and SSRIs are not effective for pain and cause myriad side effects including weight gain, agitation and worsening of muscle tightness as well as SSRI intolerance (anxiety, muscle tightness, disturbed sleep even at very low doses on Lexapro, Effexor, Cymbalta). Often I "crash" in the afternoons, similar to the symptoms of adrenal fatigue.

Do you think the elevated DHEA is causing my panic attacks and palpitations as well as the other symptoms? An endocrinologist consulted says it's due to "stress" and not to worry, but I wonder if my DHEA and DHEA-S should be re-tested and treated if found to be elevated again. It has been elevated several times over several years, though the levels that the endocrinologist tested were normal.

I would greatly appreciate advice especially as elevated DHEA relates to Chronic Fatigue Syndrome and Fibromyalgia. Thank you.

Csel
 Dr.M.Aroon kamath - Thu Jun 24, 2010 2:31 pm

User avatar Hi,
DHEA is Dehydroepiandrosterone is a precursor of the sex hormones. It is secreted by the "Zona reticularis" which is the deepest layer of the adrenal cortex.The other hormone produced in this layer is Androstenedione, which is the common precursor of the male & female sex hormones. DHEA gets sulfated & gets converted to DHEA-S. Both these(DHEA-S and Androstenedione) can not be cestes/ovaries to be further processed into the sex hormones.

DHEA levels usually begin to decline after the age of 30 at a rate of about 2% per year. By age 70, they are at about 20% of their peak levels.

DHEA in stress:
DHEA helps prevent the destruction of 5-Hydroxytryptophan (5-HTP). 5-HTP increases the production of serotonin. This helps provide added protection from chronic stress. Several studies have shown that low DHEA may be a biological marker of stress & age-related diseases such as neurosis, depression etc.

DHEA is seen to be very low in patients with fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS).
This is explained as follows:
To begin with, chronic stress causes the adrenal glands to release extra cortisol as a normal response to stress. Continuing stress raises cortisol to abnormally high levels. Thereafter, the adrenal glands get exhausted. As the cortisol levels continue to become depleted, the adrenal glands try to compensate by releasing more DHEA. Eventually they become so exhausted that they can’t produce enough of either cortisol or DHEA.

If indeed you have fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS) ahd your DHEA and DHEA-S values are elevated, one explanation for this might be that your adrenals have not yet exhausted their ability to synthesize these substances.
Best wishes!

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