What Role for DHEA-S in Chronic Fatigue Syndrome?

My patient complains of chronic fatigue. Her complete blood cell count and thyroid-stimulating hormone level are normal. Would it be worthwhile to measure her dehydroepiandrosterone sulfate (DHEA-S) level?

- MD

The bulk of the available literature seems to indicate that persons with chronic fatigue syndrome (CFS) have decreased levels of DHEA or its sulfate, DHEA-S. However, a recent study that compared those who had CFS with a group of controls did not find any difference in DHEA-S levels between the groups.¹ In another study, DHEA levels were found to be elevated in persons with CFS.²

Cortisol, DHEA, and DHEA-S are secreted by the adrenal glands in response to secretions from the hypothalamus and the pituitary gland. The literature does not point to a specific or uniform dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis in persons with CFS. This may be because many factors--such as activity level, sleep disturbances, medication, and stress--influence the HPA axis.

In clinical practice, the reason for assessing a patient's level of DHEA or DHEA-S would be to determine whether supplementation with these agents is needed. In a recent prospective observational study, Bentler and colleagues³ evaluated the effectiveness of a number of commonly used therapies for CFS, including prescription medications, over-the-counter supplements, lifestyle changes, alternative therapies, and psychological support. The treatments that patients found most helpful were coenzyme Q10, DHEA, ginseng, and yoga.

As these results suggest, treatments for CFS are still under investigation, and no consensus has yet been reached on the optimal therapy. However, you might encourage your patient to try any 1 of the 4 treatments that proved most helpful in the Bentler study. Before advising a patient to use DHEA supplements, you may want to measure his or her plasma DHEA and DHEA-S levels to determine whether they are lower than those of healthy persons of the same age and sex.

- Laure Buydens-Branchey, MD
   Veterans Administration New York Harbor Healthcare System
   Brooklyn

References:

REFERENCES:1. Inder WJ, Prickett TC, Mulder RT. Normal opioid tone and hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome despite marked functional impairment. Clin Endocrinol (Oxf).Clin Endocrinol (Oxf)CliClin2005;62:343-348.
2. Cleare AJ, O'Keane V, Miell JP. Levels of DHEA and DHEAS and responses to CRH stimulation and hydrocortisone treatment in chronic fatigue syndrome. Psychoneuroendocrinology.sychoneuroendocrinolo 2004;29:724-732.
3. Bentler SE, Hartz AJ, Kuhn EM. Prospective observational study of treatments for unexplained chronic fatigue. J Clin Psychiatry.J Clin Psychi 2005;66:625-632.