Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Are Elevated DHEA-s Levels In A Child A Cause For Concern?
Question: My 7 year old daughter has a DHEA-s level of 175, the next time we tested it was 142. She is slightly anemic, she has had 4 skin infections in a year, and she is getting acne. We have tested 3 other hormones, I know one was testosterone and all came back normal. She had a bone age test and it was normal. No physical signs of puberty. Our doctor is dismissing us saying it is an isolated incident. He continues to tell me to get her to lose weight (she is only slightly overweight). My fear is that we have not eliminated things like an adrenal tumor, pituitary tumor or cushings syndrome. Our doctor says he has spoken with an endocrinologist and she agrees with him. In all my reading and research I have not found anything that says high DHEA-s can be an isolated incident in a child. To me, it says something is going on with my daughter's body. I would like to know what your opinion is?
Thank you, XXXXXXX
Thank you, XXXXXXX
Brief Answer:
Adrenarche
Detailed Answer:
Good day,
Noted your concern.
DHEA-S is a hormone produced by adrenal gland. This is an androgen ( malehormone). Levels of DHEA-s start to elevate few years prior to menarche. Soon after the DHEA-S levels go up, kids tend to develop pubic and axillary hair. Some may even develop acne. this phase is called as adrenarche. Your daughter is in her correct age of adrenarche. What is her height, weight and exact age ( year and month). Excess weight itself can push up the level of DHEA-S . Excess weight is a risk factor for early adrenarche and menarche. So your doctor is right. In adrenal tumours producing excess male hormones, the levels of DHEA-S will be much higher ( 700-800). Well, i should say mid cushing syndrome is diffcult to diagnose unless we test it. But if your daughter is growing well as per her age, then cushings is unlikely. Because, cushings syndrome will usually retard the height. You may take an appointment with a pediatric endocrinologist to examine her and to decide if any further action is required.
Reducing the weight is certainly useful.
Regards
Binu
Adrenarche
Detailed Answer:
Good day,
Noted your concern.
DHEA-S is a hormone produced by adrenal gland. This is an androgen ( malehormone). Levels of DHEA-s start to elevate few years prior to menarche. Soon after the DHEA-S levels go up, kids tend to develop pubic and axillary hair. Some may even develop acne. this phase is called as adrenarche. Your daughter is in her correct age of adrenarche. What is her height, weight and exact age ( year and month). Excess weight itself can push up the level of DHEA-S . Excess weight is a risk factor for early adrenarche and menarche. So your doctor is right. In adrenal tumours producing excess male hormones, the levels of DHEA-S will be much higher ( 700-800). Well, i should say mid cushing syndrome is diffcult to diagnose unless we test it. But if your daughter is growing well as per her age, then cushings is unlikely. Because, cushings syndrome will usually retard the height. You may take an appointment with a pediatric endocrinologist to examine her and to decide if any further action is required.
Reducing the weight is certainly useful.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good Morning Dr. XXXXXXX
Thank you for getting back to me so quickly. We are going to have a consult with a pediatric endocrinologist over the phone, unfortunately our specialists are a 2 hour drive away. Thank you for the information on the adrenal tumors, I have mentioned my concern several times and nobody has bothered to tell me that the DHEA-s should be that high to indicate a tumor. My daughter is 82 lbs and 56". I know this puts her somewhere in the 90th percentile for the growth chart and ideal weight is supposed to be somewhere around 85th percentile. But when you look at my daughter, so does not look very overweight, all she has is a little bit of a belly, her arms and legs are fairly normal. Her exact age is 7 and 10 months (to the day yesterday). Here is what I don't understand. My daughter had the acne and she also has mood swings. Why don't I see this in other 7 and 8 year olds? There are many other kids at her school that are way more overweight that she is and I see no other kids that are dealing with acne. Trust me, I have looked. She is not that overweight, why is she dealing with this when nobody else is? That is what I really don't understand. One other thing to mention is that I have Polycystic Ovarian Syndrome. I wanted the doctor to test her and see if there is anything going in that direction but the testosterone came back normal. I have read with the premature adrenarche, those girls are more at risk to become polycystic. If there is anything going on in the Polycystic direction then she may have a harder time losing the weight or her additional weight could be part of the syndrome. I have struggled with the weight issue with Polycystic and I know for a fact that it is much easier to gain weight and much more difficult to lose weight with this syndrome. What are your thoughts?
Thank you, XXXXXXX
Thank you for getting back to me so quickly. We are going to have a consult with a pediatric endocrinologist over the phone, unfortunately our specialists are a 2 hour drive away. Thank you for the information on the adrenal tumors, I have mentioned my concern several times and nobody has bothered to tell me that the DHEA-s should be that high to indicate a tumor. My daughter is 82 lbs and 56". I know this puts her somewhere in the 90th percentile for the growth chart and ideal weight is supposed to be somewhere around 85th percentile. But when you look at my daughter, so does not look very overweight, all she has is a little bit of a belly, her arms and legs are fairly normal. Her exact age is 7 and 10 months (to the day yesterday). Here is what I don't understand. My daughter had the acne and she also has mood swings. Why don't I see this in other 7 and 8 year olds? There are many other kids at her school that are way more overweight that she is and I see no other kids that are dealing with acne. Trust me, I have looked. She is not that overweight, why is she dealing with this when nobody else is? That is what I really don't understand. One other thing to mention is that I have Polycystic Ovarian Syndrome. I wanted the doctor to test her and see if there is anything going in that direction but the testosterone came back normal. I have read with the premature adrenarche, those girls are more at risk to become polycystic. If there is anything going on in the Polycystic direction then she may have a harder time losing the weight or her additional weight could be part of the syndrome. I have struggled with the weight issue with Polycystic and I know for a fact that it is much easier to gain weight and much more difficult to lose weight with this syndrome. What are your thoughts?
Thank you, XXXXXXX
Hi Dr. XXXXXXX
I made a mistake with her height. It is actually 53"
Thank you, XXXXXXX
Hi Dr. XXXXXXX
Another correction. I just spoke to the Endocrinologist and she said the Bone Age test was NOT normal. She said XXXXXXX has 10 year old bones in some areas and 9 year old bones in other areas.
Thank you, XXXXXXX
I made a mistake with her height. It is actually 53"
Thank you, XXXXXXX
Hi Dr. XXXXXXX
Another correction. I just spoke to the Endocrinologist and she said the Bone Age test was NOT normal. She said XXXXXXX has 10 year old bones in some areas and 9 year old bones in other areas.
Thank you, XXXXXXX
Brief Answer:
Risk of PCOS
Detailed Answer:
Hi,
Sorry for the delay in reply. {Time zone related delay}
She is overnight.However, you mentioned about belly. Visceral adiposity ( fat in mid portion of body) is an independent risk factor of poly cystic ovary syndrome and early puberty. This is particularly an issue when there is family history of PCOS. It would be good to keep her weight around 50th percentile for her age. Please avoid comparison with other kids. Each kid is different and family history should always be considered. Early adrenarche and early puberty are ris factors for poly cystic ovary syndrome.
2 years of advanced Bone age is a concern. This need close observation. This may indicate premature adrenarche progressing to premature puberty . ( however, 8 years of age is the cut off for girls for defining premature puberty in western countries). Acne could be due to high adrenal androgens. I would be very interested to see her ovarian size, uterus length and volume in ultrasound as well her fasting blood tests like LH, FSH, Estradiol.We should also get a thyroid blood profile. If necessary, your endocrinologist will perform a GNRH stimulation test. ( simple Outpatient procedure).
However, she is close to 8 years. As i mentioned earlier, western endocrine community consider that 8 yrs and above is okay in terms of puberty and it can not be considered as premature puberty beyond 8 years. Does she have breast development along with Acne?
Risk of PCOS
Detailed Answer:
Hi,
Sorry for the delay in reply. {Time zone related delay}
She is overnight.However, you mentioned about belly. Visceral adiposity ( fat in mid portion of body) is an independent risk factor of poly cystic ovary syndrome and early puberty. This is particularly an issue when there is family history of PCOS. It would be good to keep her weight around 50th percentile for her age. Please avoid comparison with other kids. Each kid is different and family history should always be considered. Early adrenarche and early puberty are ris factors for poly cystic ovary syndrome.
2 years of advanced Bone age is a concern. This need close observation. This may indicate premature adrenarche progressing to premature puberty . ( however, 8 years of age is the cut off for girls for defining premature puberty in western countries). Acne could be due to high adrenal androgens. I would be very interested to see her ovarian size, uterus length and volume in ultrasound as well her fasting blood tests like LH, FSH, Estradiol.We should also get a thyroid blood profile. If necessary, your endocrinologist will perform a GNRH stimulation test. ( simple Outpatient procedure).
However, she is close to 8 years. As i mentioned earlier, western endocrine community consider that 8 yrs and above is okay in terms of puberty and it can not be considered as premature puberty beyond 8 years. Does she have breast development along with Acne?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the information Dr. XXXXXXX We are actually going to see the endocrinologist next Wednesday, luckily she will be in a hospital near us that day and could see us. I will mention the testing you mentioned above, thank you for that. I will let you know what the Endocrinologist says. Any other advice for us when we go see the Endocrinologist?
She did have some simple thyroid blood tests, the THS and the T4, those came back normal. No breast development.
Thank you, XXXXXXX XXXXXXX
She did have some simple thyroid blood tests, the THS and the T4, those came back normal. No breast development.
Thank you, XXXXXXX XXXXXXX
Brief Answer:
good
Detailed Answer:
Thats good to know.
You will have to discuss about the advancement in bone age and to look for ny evidence of premature puberty. If there is no breast development now, there is not a big worry. Meet endocrinologist with an ope mind. Let them see her first and investigations will only be conducted if absolutely necessary. It would be great if you could let me know the outcome of the consultation.
regards
Binu
good
Detailed Answer:
Thats good to know.
You will have to discuss about the advancement in bone age and to look for ny evidence of premature puberty. If there is no breast development now, there is not a big worry. Meet endocrinologist with an ope mind. Let them see her first and investigations will only be conducted if absolutely necessary. It would be great if you could let me know the outcome of the consultation.
regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. XXXXXXX
Thank you for all your assistance. I will definitely let you know how things turn out. I'll follow up with you after Wed. the 24th.
Best Regards, XXXXXXX XXXXXXX
Thank you for all your assistance. I will definitely let you know how things turn out. I'll follow up with you after Wed. the 24th.
Best Regards, XXXXXXX XXXXXXX
Brief Answer:
SURE
Detailed Answer:
you are welcome. Wish your daughter good XXXXXXX
SURE
Detailed Answer:
you are welcome. Wish your daughter good XXXXXXX
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
