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DHEA(S)—a novel marker in Cushing’s disease

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Introduction

Dehydroepiandrosterone sulfate (DHEA(S)) is a multi-functional steroid implicated in a broad range of biological effects, including obesity, diabetes, bone metabolism, neuroprotection, and anti-tumorigenesis. It has not yet undergone wider research in the context of Cushing’s disease. The objective of this study was to determine if perioperative blood levels of DHEA(S) correlate with levels of ACTH and cortisol, and therefore may be useful as a new, additional marker for the early definition of cure in patients suffering from Cushing’s disease.

Methods

Forty-two consecutive patients undergoing transsphenoidal surgery for Cushing’s disease from September 2009 to September 2010 were perioperatively monitored for ACTH, cortisol, and DHEA(S).

Results

Pre-operative blood samples revealed ACTH levels of median 65 ng/l (range 11–1,183 ng/l, standard deviation 183.76), cortisol of median 257 μg/l (range 93–803 μg/l, standard deviation 140.88), and DHEA(S) of median 2.22 mg/l (range 0.44–7.79 mg/l, standard deviation 1.82) according to the pathology of Cushing’s disease. Postoperative blood samples drawn over a 7-day time span showed a drop in median ACTH to just 14.5 % (median: 9 ng/l, range 2–44, standard deviation 12.75) of its median preoperative figure. Median cortisol levels were reduced to 6.9 % (median: 18 μg/l, range 10–190 μg/l, standard deviation 38.04) of their preoperative values and DHEA(S) levels decreased to 17 % (median: 0.38 mg/l, range 0.05–2.29, standard deviation 0.51). In persistent disease, no patient showed a drop in DHEA(S) below 38 % of its preoperative figures.

Conclusions

DHEA(S) shows the potential to become an additional marker in the diagnosis and follow-up of patients. However, it needs to be examined further, including whether DHEA(S) may also be a useful predictor of recovery of the HPA-axis after successful surgery.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, Hamburg University Medical Center, Hamburg, Germany

    T. Burkhardt, N. O. Schmidt & J. Flitsch

  2. Department of Medical Biometry and Epidemiology, Hamburg University Medical Center, Hamburg, Germany

    E. Vettorazzi

  3. Department of Endocrinology, Hamburg University Medical Center, Hamburg, Germany

    J. Aberle

  4. Endocrinological Practice, Wuppertal, Germany

    M. Mengel

  5. Abteilung für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany

    T. Burkhardt

Authors
  1. T. Burkhardt
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  2. N. O. Schmidt
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  3. E. Vettorazzi
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  4. J. Aberle
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  5. M. Mengel
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  6. J. Flitsch
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Corresponding author

Correspondence to T. Burkhardt.

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Comment

This is a thought-provoking and interesting article that any surgeon in the Cushing’s field will find of great interest. Where DHEA will take us may prove of importance. It is also worth noting how a center that can find 42 Cushing’s cases in a year and cure the vast majority, can really focus on ways to improve outcome in this dangerous and difficult disease, underlining the often-ignored fact that experience in a rare disease usually improves outcome. Specialist centers really make a difference.

Michael Powell,

London, UK

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Burkhardt, T., Schmidt, N.O., Vettorazzi, E. et al. DHEA(S)—a novel marker in Cushing’s disease. Acta Neurochir 155, 479–484 (2013). https://doi.org/10.1007/s00701-012-1596-6

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  • DOI: https://doi.org/10.1007/s00701-012-1596-6

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