Secondary and primary adrenal insufficiency (Addison’s disease) are associated with very low circulating DHEAS levels. Patients without both adrenal glands due to treatment for Cushing’s are considered to have primary adrenal insufficiency. Whilst glucocorticoid (cortisol ) and mineralocorticoid (aldosterone) deficiencies are treated with daily medication, the associated failure of adrenal DHEA synthesis is not usually corrected, despite this substance being available in the US as a natural dietary supplement.

Despite optimal conventional steroid replacement therapy, patients with Addison’s disease report persistent fatigue and reduced well-being. In a previous randomized, placebo-controlled trial 3 month study in 39 men and women with Addison’s disease, we observed an improvement in mood and fatigue in both sexes (1, 2). We have just completed a longer-term, 12 month trial of 50 mg DHEA replacement in 100 patients with Addison’s disease and the preliminary results show positive effects on lean body mass, bone mineral density and once again improved fatigue and well-being.

If the outcome of further such studies is also positive, the addition of DHEA to other steroid hormone replacement therapy for this disorder may enter routine clinical practice. While patients with primary adrenal insufficiency due to bilateral adrenalectomy were not specifically studied, DHEA replacement in these patients may also prove beneficial (3). DHEA levels can easily be determined from a blood test. As always, check with your doctor before beginning any DHEA replacement.

Author: Dr. Eleanor M. Gurnell, MD, (Spring, 2003)

Editor’s Note: Dr. Gurnell is an endocrinologist in the Department of Medicine, University of Cambridge, Cambridge, United Kingdom

References

1 Gurnell EM Chatterjee VK. Dehydroepiandrosterone replacement therapy. Eur J Endocrinol. 2001 Aug;145(2):103-6.

2 Hunt PJ, Gurnell EM, Huppert FA, Richards C, Prevost AT, Wass JA, Herbert J, Chatterjee VK. Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison’s disease in a randomized, double blind trial. J Clin Endocrinol Metab. 2000 Dec;85(12):4650-6.

3 Arlt W, et al Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med. 1999 Sep 30;341(14):1013-20.