Dehydroepiandrosterone-Sulphate in Diagnosing Mild Autonomous Cortisol Secretion and Adrenal Insufficiency

Objective Data on diagnostic accuracy of Dehydroepiandrosterone sulfate (DHEA-S) for mild autonomous cortisol secretion (MACS) and adrenal insufficiency (AI) are discrepant. We conducted a systematic review and meta-analysis of published studies assessing the accuracy of DHEA-S in diagnosing MACS or AI. Methods From inception to January 8th, 2024, we searched databases for original studies of at least 20 participants with MACS or AI. MACS was defined as post-dexamethasone cortisol >1.8 mcg/dL or postsurgical hypocortisolism. AI was defined by abnormal dynamic testing. QUADAS-2 was used to assess the risk of bias. Bivariate random effects meta-analysis was used to generate pooled diagnostic accuracy estimates. Results Seven studies on DHEA-S accuracy in diagnosing MACS (574 patients with MACS, 830 referent subjects) and 2 studies on DHEA-S accuracy in diagnosing AI (52 patients with AI, 59 referent subjects) were included. A meta-analysis of studies using DHEA-S cutoff between 60-70 mcg/dL to diagnose MACS demonstrated a sensitivity of 82% (95% CI: 64-93) and a specificity of 82% (95% CI: 74-88). In the two studies evaluating DHEA-S in diagnosing AI, the reference standard was a 1-mcg-cosyntropin stimulation test. The sensitivity of DHEA-S for diagnosing AI ranged from 70.3 to 86.7%, and the specificity was 87.1%. Most studies were at a moderate risk of bias. Conclusion Based on limited heterogeneous evidence, measurement of DHEA-S provides additional value in diagnosing MACS, as well as AI.