Relationship between Serum Dehydroepiandrosterone Levels and Heart Ejection Fraction in Heart Failure Patients

Cardiovascular disease is still a serious problem in the world of health. Life expectancy after being diagnosed with heartfailure is 50% and 10% for 5 and 10 years. Steroid hormones such as Dehydroepiandrosterone (DHEAS) havecardioprotective effects by inhibiting the formation of atherosclerotic plaque, pulmonary artery vasodilators, and protectingcardiomyocytes. DHEAS levels decrease with age. Decreased DHEAS levels are associated with an increased risk ofcardiovascular disease. This study aimed to know the relationship between DHEAS levels in serum and ejection fractions inheart failure patients. This cross-sectional study used a sample of 34 people aged > 30 years who had been diagnosed withheart failure by a specialist in the Department of Cardiology and Vascular Medicine. The diagnosis of heart failure usesEchocardiography to determine the ejection heart fraction. DHEAS levels were taken from venous blood and examinedusing the CLEIA method with an IMMULITE device (Siemens Healthineers, Germany). Statistical analysis was performed bySpearman correlation test, with a significance level of p < 0.05. Thirty-four research subjects found that 13 patients had anejection fraction of 40% (Heart Failure with Reduced Ejection Fraction/HFrEF), 12 patients had an ejection fraction of 41-49%(borderline) and 9 patients had an ejection fraction of ≥ 50% (Heart Failure with Preserved Ejection Fraction/HFpEF).Spearman correlation test results obtained a correlation coefficient or r=0.357 with a value of p=0.038, which meant therewas a significant relationship between DHEAS with ejection fraction (p < 0.05). The lower the DHEAS level, the ejectionfraction would also be lower. Further with age, DHEAS levels get lower. The lower the DHEAS level, the lower the ejectionfraction.

SUN-169 A Rare Case of Adrenocortical Carcinoma Presenting as Hyperaldosteronism Combined with Cushing’s Syndrome

Introduction: Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis. Most ACC cases are hormonally functional. Commonly produced hormones are cortisol, followed by adrenal androgens. Aldosterone secretion is quite rare (&lt; 2%) (1). Co-secretion of multiple hormones is further rare. Case Presentation: A 59 year old female presented with progressive worsening hypertension. Initial biochemical evaluation confirmed primary hyperaldosteronism. Her potassium was low at 2.9 mEq/L (N: 3.5-5.3 meq/L). Aldosterone level was elevated at 23 ng/dL (N: &lt; or = 28 ng/mL), renin value was 0.90 ng/mL/h (N: 0.25-5.82 ng/mL/h). Aldosterone Renin Ratio was 25. CT abdomen with and without contrast showed 2 lesions within the right adrenal gland. The larger nodule was 3.7 x 2.7 x 4.9 cm with an absolute washout of 61%. A smaller nodule was 2.3x1.8 cm with an absolute washout of approximately 64%. Left adrenal gland was unremarkable. Further biochemical workup showed plasma catecholamines and metanephrines were normal. A random cortisol value was 22.8 mcg/dL (N: 3.0-16.0 mcg/dL) with a low ACTH level of 3.3 pg/mL (N: 7.2 - 63.3 pg/mL). Given suspicion for adrenal Cushing’s syndrome, we further obtained a 24 hour free urinary cortisol which was elevated at 84.1 mcg/24 h (N: 4-50 mcg/24 h). 8 am Cortisol after an overnight 1 mg Dexamethasone failed to suppress at 17.5 mcg/dL (n&lt;1.8 mcg/dL). DHEAS level was low at 14.1 ug/dL (N: 29.4-220.5 ug/dL). The patient eventually underwent a right adrenalectomy. Post-operatively, her cortisol was suppressed at 1.9 mcg/dL (8 am ref range: 4-22 mcg/dL), and Hydrocortisone replacement dose was initiated. Surgical pathology report was consistent with adrenocortical carcinoma. The patient continues to follow-up with the endocrinology and oncology department for treatment. Conclusion: This case is particularly interesting given the co-secretion of both aldosterone and cortisol by an adrenocortical carcinoma which has been reported in only a few cases in literature. The case highlights the importance of completing a comprehensive biochemical workup pre-operatively in patients with suspicious adrenal mass. There should especially be a low threshold for initiating workup for cortisol hypersecretion as early intervention can help avoid an adrenal crisis in the post-operative period for such patients. A low DHEAS level should raise suspicion for cortisol hypersecretion in a patient with adrenal lesions. As ACTH is the primary stimulant of DHEA, the suppression of ACTH secretion in the setting of adrenal Cushing’s syndrome can contribute to a low DHEAS level. Reference 1.Else, T et al. Adrenocortical Carcinoma. Endocr Rev. 2014; 35(2):282-326.

Role of yoga and meditation on serum DHEAS level in first year medical students

Background: Dehydroepiandrosterone sulfate (DHEAS), secreted by adrenal cortex, acts in the human body as a neurosteroid, cardio-protective, anti-diabetic, anti-obesity and immune-enhancing agent. It is also reported as a youth hormone. But due to various stimulators of stress, and also as an antagonist of cortisol, DHEAS level decreases. Yoga and meditation regulates the level of hormones and neurotransmitters that affect physiological function.Methods: This study was performed on 1st yr. medical students whose DHEAS level was low due to acute stress. 55 medical students were selected as participants through counseling and were divided into Yoga group (n= 27) and control group (n=28). Their morning serum DHEAS level was assessed and yoga group were instructed to practice Yoga (1hr/day for 12 weeks) under supervision of Yoga instructor. No such instruction was given to control group.Results: As a marker of youth and immunity, increase in DHEAS level decreases susceptibility to infections, reduces aging process as well as improves other functions. Yoga and meditation is documented to increase DHEAS level in regular practitioners. Statistical analysis has shown an increase in morning S. DHEAS level in yoga practitioners. Pre-study and post study values were 3.5±2.48 and 3.61±1.73 respectively in yoga group (overall 3.1% increase, P Value = 0.025, significant at 0.05) whereas 3.36±1.98 and 2.58±1.49 respectively in control group (23.2% decrease, P Value =0.84, not significant).Conclusions: This study concludes that practicing Yoga has significantly raised S. DHEAS level in medical students and improved their immunological status as well as enhances mood and behavior.

Marked hyperandrogenicity in a 60-year-old woman

Markedly elevated androgen levels can lead to clinical virilization in females. Clinical features of virilization in a female patient, in association with biochemical hyperandrogenism, should prompt a search for an androgen-producing tumor, especially of ovarian or adrenal origin. We herein report the case of a 60-year-old woman of Pakistani origin who presented with the incidental finding of male pattern baldness and hirsutism. Her serum testosterone level was markedly elevated at 21 nmol/L (normal range: 0.4–1.7 nmol/L), while her DHEAS level was normal, indicating a likely ovarian source of her elevated testosterone. Subsequently, a CT abdomen-pelvis was performed, which revealed a bulky right ovary, confirmed on MRI of the pelvis as an enlarged right ovary, measuring 2.9 × 2.2 cm transaxially. A laparoscopic bilateral salpingo-oophorectomy was performed, and histopathological examination and immunohistochemistry confirmed the diagnosis of a Leydig cell tumor, a rare tumor accounting for 0.1% of ovarian tumors. Surgical resection led to normalization of testosterone levels. Learning points: Hirsutism in postmenopausal women should trigger suspicion of androgen-secreting tumor Extremely elevated testosterone level plus normal DHEAS level point toward ovarian source Leydig cell tumor is extremely rare cause of hyperandrogenicity

Testosterone- and Cortisol-Secreting Adrenocortical Oncocytoma: An Unusual Cause of Hirsutism

Objective.Oncocytomas of the adrenal cortex are usually benign and nonfunctional. They are rarely seen as the cause of hirsutism. Therefore, we aimed to report a case of adrenocortical oncocytoma presenting with hirsutism.Methods.We report a testosterone- and cortisol-secreting adrenal oncocytoma in a 23-year-old female patient presenting with hirsutism.Results.The patient had the complaint of hirsutism for the last year. Laboratory tests revealed total testosterone level of 4.2 ng/mL, free testosterone of >100 pg/mL, and DHEAS level of 574 µg/dL. There was no suppression in cortisol levels with 2 mg dexamethasone suppression test (5.4 µg/dL). Adrenal MRI revealed a27×25 mm isointense solid mass lesion in the left adrenal gland and the patient underwent laparoscopic left adrenalectomy. Pathological examination confirmed the diagnosis of benign adrenocortical oncoyctoma.Conclusion.This well-characterized case describes a testosterone- and cortisol-secreting adrenocortical oncocytoma as a possible cause of hirsutism. To our knowledge, this is the second report in the literature. Adrenal oncocytomas should always be considered in the differential diagnosis of hirsutism.

Genes for Enzymes Regulating Dehydroepiandrosterone Sulfonation Are Associated with Levels of Dehydroepiandrosterone Sulfate in Polycystic Ovary Syndrome

Context: The adrenal androgen (AA) metabolite dehydroepiandrosterone sulfate (DHEAS) is often elevated in women with polycystic ovary syndrome (PCOS); AA excess in PCOS appears to be, in part, a heritable trait. Dehydroepiandrosterone (DHEA) sulfonation is controlled by the enzymes DHEA sulfotransferase (SULT2A1) and steroid sulfatase (STS). Polymorphisms in these genes have not been evaluated as modulators of DHEAS level in PCOS. Objective: The aim was to test the hypothesis that variants in the SULT2A1 and STS genes are associated with DHEAS levels in women with PCOS. Design: Women with and without PCOS were genotyped for seven single nucleotide polymorphisms (SNPs) in SULT2A1 and seven SNPs in STS. SNPs and haplotypes were determined and tested for association with DHEAS. Setting: Subjects were recruited from the reproductive endocrinology clinic at the University of Alabama at Birmingham; controls were recruited from the surrounding community. Genotyping took place at Cedars-Sinai Medical Center in Los Angeles. Participants: A total of 287 white women with PCOS and 187 controls participated in the study. Main Measurements: SULT2A1 and STS genotype and DHEAS levels were measured. Results: In women with PCOS, SNP rs182420 in SULT2A1 was associated with DHEAS (P = 0.0035). Two haplotypes carrying the minor allele of rs182420 were also associated with DHEAS (P = 0.04 each). Variants within STS were not associated with DHEAS level. No associations were observed in control women. Conclusion: This study presents genetic evidence suggesting a potential role of SULT2A1, but not STS, in the inherited AA excess of PCOS.

Human Immunodeficiency Virus Infection and Levels of Dehydroepiandrosterone Sulfate in Plasma among Indians

ABSTRACT The shift in cytokine profile during human immunodeficiency virus (HIV) disease progression is influenced by dehydroepiandrosterone sulfate (DHEAS) level. Radioimmunoassay was used to measure plasma DHEAS for 30 treatment-naïve HIV-infected and 30 uninfected individuals. There was a significant negative correlation of viral load with DHEAS level (P < 0.05). Further studies of the use of DHEAS levels for monitoring HIV patients economically are warranted.