Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (892 page)

   Indicator of adrenal cortical function, especially for differential diagnosis of virilization, and investigations of hirsutism and alopecia in women. It is also of value in the assessment of adrenarche and delayed puberty.

   Differential diagnosis of Cushing syndrome.

   Replaces 17-KS urine excretion with which it correlates; shows no significant diurnal variation, thereby providing rapid test for abnormal androgen secretion.

   Interpretation

Increased In

   CAH: Markedly increased values can be suppressed by dexamethasone. Highest values occur in CAH due to deficiency of 3β-hydroxysteroid dehydrogenase.

   Adrenal carcinoma: Markedly increased levels cannot be suppressed by dexamethasone.

   Cushing syndrome caused by bilateral adrenal hyperplasia: Shows higher values than Cushing syndrome due to benign cortical adenoma, in which values may be normal or low.

   Cushing disease (pituitary etiology): Moderate increase in hypogonadotropic hypogonadism; DHEA-S is usually normal for chronologic age and high for bone age in contrast with idiopathic delayed puberty, in which DHEA-S is low relative to chronologic age and normal relative to bone age.

   First few days of life, especially in sick or premature infants.

   Polycystic ovary syndrome: Adrenal hyperandrogenism is a fairly typical facet of this syndrome.

Decreased In

   Addison disease

   Adrenal hypoplasia

   Limitations