In women with anorexia nervosa (AN), elevated levels of the sulfated form of the adrenal androgen dehydroepiandrosterone (DHEAS) may predict weight gain and higher overall gains in fat mass, skeletal muscle mass, and abdominal fat, according to study results intended to be presented at the annual meeting of the Endocrine Society (ENDO 2020). In this light, serum DHEAS may constitute a reliable and efficient marker of recovery in patients with AN, a condition that can be complicated by endocrine dysregulation.

Allison Kimball, MD, of the neuroendocrine unit at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts, and colleagues examined women with AN and atypical AN (N=34; mean age, 27.4±7.7 years; mean weight, 51.3±4.9 kg) who received a placebo in a randomized trial. They made diagnoses through structured interviews and determined weight and body composition with dual-energy x-ray absorptiometry and cross-sectional abdominal computed tomography scans at baseline and 6-month follow-up. In addition, the investigators measured DHEAS and 24-hour urinary free cortisol levels with liquid chromatography and mass spectrometry.

In the cohort, mean DHEAS levels (173±70 µg/dL) were 0.7±0.3 times the mean normal range, whereas mean baseline urinary free cortisol (20±18 µg/24 h) for the 15 women who completed testing was in the normal range of 0 to 50 µg/24 h. Of the patients who gained weight (n=18; range, 0.1-10.3 kg), 28% were eumenorrheic, 39% were amenorrheic, and 33% were on oral contraceptives at baseline.

Elevated levels of DHEAS at baseline predicted weight gain over a 6-month period (r=0.61; P <.001), a finding that remained significant after adjustments for covariates. Furthermore, baseline levels of DHEAS predicted increased fat mass (r=0.40; P =.03), appendicular lean mass (r=0.38; P =.04), and abdominal fat (r=0.60; P <.001), which also remained significant after adjusting for covariates. The researchers noted that urinary free cortisol, although directly correlated with DHEAS (r=0.61; P =.02), did not predict alterations in weight (r=0.37; P =.17) or body composition.


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While prior studies suggest that elevated urinary free cortisol can predict weight gain in women with AN, the investigators noted that “24-hour urine collections are not feasible in a real-world setting.” Their findings indicate that DHEAS may be “a more practical biomarker of recovery,” although more research is necessary to determine the relationship between DHEAS, global adrenal stress responses, and weight gain in AN.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Kimball A, Haines MS, Meenaghan E, et al. Dehydroepiandrosterone sulfate (DHEAS) levels predict weight gain in women with anorexia nervosa. J Endocr Soc. 2020;4(suppl 1):SAT-167.

This article originally appeared on Endocrinology Advisor