Dehydroepiandrosterone sulfate, C
19H
28O
5S, (5-androsten-3ß, 16a-diol-17-one sulfate, DHEA-S) is the major C19 steroid secreted by the adrenal cortex, and is a precursor in testosterone and estrogen biosynthesis. It is produced by the addition of a sulfate group to dehydroepiandrosterone (DHEA), catalyzed by the sulfotransferase enzymes, SULT1A1 and SULT1E1, which also produce estrone sulfate from estrone. DHEA sulfate can also be back-converted to DHEA through the action of steroid sulfatase. DHEA-S has relatively low androgenic activity due to the 17-ketone group rather than hydroxyl group. However the bioactivity of DHEA-S may be high due to its high serum concentrations at 100-1,000-fold higher than testosterone or DHEA and its weak afffnity for sex-hormone binding globulin.

The physiological role of DHEA-S is not well deffned, with serum levels being high in the fetus and neonates, low during childhood and increased during puberty. DHEA-S levels decline during the third decade of life. DHEA-S, unlike DHEA and other steroids, does not show a signiffcant diurnal or day-to-day variation. DHEA-S levels are not increased due to ACTH administration and do not change signiffcantly during the normal menstrual cycle. DHEA-S has a lower metabolic clearance rate than DHEA.
Since DHEA-S is primarily produced by the adrenal glands, it is useful as a marker for adrenal function. Adrenal tumors, cancers, and hyperplasia can lead to the overproduction of DHEA-S. While elevated levels may not be noticed in adult men, they can lead to amenorrhea and visible symptoms of virilization. These changes vary in severity and may include a deeper voice, hirsutism, male pattern baldness, muscularity, acne and enlargement of the Adam's apple. Women with polycystic ovary syndrome tend to have elevated levels of DHEA-S. Excess levels of DHEA-S in children can cause precocious puberty in boys; and ambiguous external genitalia, excess body hair, and abnormal menstrual periods in girls.
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