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Ovarian Cancer (Expert Forum)
DHEA levels......cyst/tumor??
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center
Boston - MA
DHEA levels......cyst/tumor??
by casper1991, Jan 23, 2007 12:00AM
FINALLY I got thru to you to post my question :) DR. YOU ARE GREAT for doing this forum!!
My question is about DHEA. Mine is currently at 2227. I am 34 and have had 3 kids. A LEEP done in 10/3/2003 for 8 lesions, tubal ligation, and exploritory. Started having pains during menstrual cycle a yr ago. CA 125 is 34. CT showed a cyst/tumor on left ovary measuring 2.3 X 2.8 in Nov 06. Another CT shows "fluid" leaking from it. DR is stumpped why DHEA is so high. Been to endocrinologist, OB and others...all come with possible ovarian cancer. ALL the symptoms. Everything getting worse. Blod results getting higher and higher. DHEA was 894 4 months ago, then 1127, now 2227 and havent tested again since 1/2/07.
Have you ever dealt with DHEA levels like this?? What are the odds that I'll need surgery? I see an OB/Oncologist next Monday.
Just want to know what questions to ask her as well.
Thanks.
My question is about DHEA. Mine is currently at 2227. I am 34 and have had 3 kids. A LEEP done in 10/3/2003 for 8 lesions, tubal ligation, and exploritory. Started having pains during menstrual cycle a yr ago. CA 125 is 34. CT showed a cyst/tumor on left ovary measuring 2.3 X 2.8 in Nov 06. Another CT shows "fluid" leaking from it. DR is stumpped why DHEA is so high. Been to endocrinologist, OB and others...all come with possible ovarian cancer. ALL the symptoms. Everything getting worse. Blod results getting higher and higher. DHEA was 894 4 months ago, then 1127, now 2227 and havent tested again since 1/2/07.
Have you ever dealt with DHEA levels like this?? What are the odds that I'll need surgery? I see an OB/Oncologist next Monday.
Just want to know what questions to ask her as well.
Thanks.
Doctor's Answer
by Annekathryn Goodman, M.D., Jan 23, 2007 12:00AM
, Jan 23, 2007 12:00AM
hi There,
I have pasted below a great summary of DHEA. It comes from UpToDate.Androgen is the general term for a certain category of hormone that has "male" effects.
I can think of several reasons why your DHEA is elevated:
1. You are getting DHEA from some food or supplement source. Many supplements and alternative therapies have mixtures of compounds. The manufacturers are not required to accurately label the ingredients for products that are labeled 'food supplements. so DHEA could be present in a vitamin mixture, an herbal mixture, and so on
2 You are producing DHEA internally from either your adrenal gland or your ovary. usually tumors - benign or malignant can produce DHEA. With the cyst on your ovary, it is possible that that is the source. However, cysts are very common on the ovary. You should ask you doctor if the CT scan you got had an adrenal protocol. With an adrenal protocol ct scan, extra thin sections of the region around the adrenal glands are examined.
if an external source of DHEA has been ruled out and your adrenal glands look normal, the next step would be to remove that ovarian cyst surgically.
best wishes to you.
DHEA from UptoDate
Premenopausal women — The major androgens in the serum of normal cycling women are dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione (A), testosterone (T), and dihydrotestosterone (DHT) in descending order of serum concentrations .
Though abundant in the circulation, DHEA-S, DHEA, and A may be considered pro-hormones requiring conversion to T or DHT to express their androgenic effects. Androgens are mainly produced in the adrenal gland, the ovary and from the peripheral conversion of pro-hormones. DHEA-S is produced solely by the adrenal gland at a rate of 3.5 to 20 mg per day . Circulating levels are in the range of 1 to 4 mcg/mL. DHEA is also produced in the adrenal gland (50 percent), the ovary (20 percent) and from peripheral conversion of DHEA-S (30 percent) with total production rates of 6 to 8 mg per day . Circulating levels are in the range of 1 to 10 ng/mL. A production is split equally between the adrenal gland and the ovary. Daily rates of production are 1.4 to 6.2 mg/day and circulating levels are in the range of 0.5 to 2 ng/mL. T is synthesized in the adrenal gland (25 percent), the ovary (25 percent) and from the peripheral conversion of A (50 percent). Daily production rates are in the range of 0.1 to 0.4 mg/day and circulating levels are between 0.2 and 0.7 ng/mL with the lowest levels found during the early follicular phase followed by a 20 percent increase at midcycle . Nearly all (99 percent) of circulating T is protein-bound (mainly to sex-hormone binding globulin [SHBG]). Therefore, any impact on SHBG concentration (eg, oral estrogen-mediated increase in SHBG) affects the concentration of the free/active androgen. Lastly, DHT is mainly a peripheral product of T conversion and has very low circulating levels .
All the major androgens are metabolized and excreted into the urine almost exclusively as 17-ketosteroids.
Putative roles for androgens — Androgens are essential precursors for estrogen synthesis. They also play an important role in follicular development. Maintenance of a precise balance of estrogens and androgens within ovarian follicles is a requirement for successful follicular maturation. In addition, many tissues have androgen receptors, including the central nervous system and bone , which has led to speculation that androgens affect their function.
It has also been proposed that androgens play a role in sexual behavior. A woman's libido is dependent upon many factors, including psychological factors . A balance of estrogen and androgen also may be necessary for normal sexual desire and responsiveness. The results of studies on the role of androgens in sexuality in normal premenopausal women are inconclusive . However, the special case of adrenal insufficiency may be an exception, as data suggests that young women with this condition may show improvement in sexuality with the addition of DHEA to their replacement regimen.
Androgens may also be important for the maintenance of normal affect, cognitive functioning and of skeletal homeostasis. Regarding the latter, a significant body of evidence exists implicating a role for androgens in the maintenance of bone health. Androgens may impact bone homeostasis directly (eg, all bone cells including osteoblasts, osteoclasts, and osteocytes have androgen receptors), or indirectly by conversion to estrogen, or by their effect on local and systemic factors that control the bone cells' microenvironment .
Low serum androgen concentrations may be associated with lower bone density and fracture risk: Serum free androgen concentrations and bone mineral density have been positively correlated in several studies . In another study, postmenopausal women with a history of vertebral crush fractures had lower serum free androgen concentrations (and similar serum estrogen values) when compared to women with no fractures . Women with hypopituitarism (who are androgen deficiency) have low bone density .
I have pasted below a great summary of DHEA. It comes from UpToDate.Androgen is the general term for a certain category of hormone that has "male" effects.
I can think of several reasons why your DHEA is elevated:
1. You are getting DHEA from some food or supplement source. Many supplements and alternative therapies have mixtures of compounds. The manufacturers are not required to accurately label the ingredients for products that are labeled 'food supplements. so DHEA could be present in a vitamin mixture, an herbal mixture, and so on
2 You are producing DHEA internally from either your adrenal gland or your ovary. usually tumors - benign or malignant can produce DHEA. With the cyst on your ovary, it is possible that that is the source. However, cysts are very common on the ovary. You should ask you doctor if the CT scan you got had an adrenal protocol. With an adrenal protocol ct scan, extra thin sections of the region around the adrenal glands are examined.
if an external source of DHEA has been ruled out and your adrenal glands look normal, the next step would be to remove that ovarian cyst surgically.
best wishes to you.
DHEA from UptoDate
Premenopausal women — The major androgens in the serum of normal cycling women are dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione (A), testosterone (T), and dihydrotestosterone (DHT) in descending order of serum concentrations .
Though abundant in the circulation, DHEA-S, DHEA, and A may be considered pro-hormones requiring conversion to T or DHT to express their androgenic effects. Androgens are mainly produced in the adrenal gland, the ovary and from the peripheral conversion of pro-hormones. DHEA-S is produced solely by the adrenal gland at a rate of 3.5 to 20 mg per day . Circulating levels are in the range of 1 to 4 mcg/mL. DHEA is also produced in the adrenal gland (50 percent), the ovary (20 percent) and from peripheral conversion of DHEA-S (30 percent) with total production rates of 6 to 8 mg per day . Circulating levels are in the range of 1 to 10 ng/mL. A production is split equally between the adrenal gland and the ovary. Daily rates of production are 1.4 to 6.2 mg/day and circulating levels are in the range of 0.5 to 2 ng/mL. T is synthesized in the adrenal gland (25 percent), the ovary (25 percent) and from the peripheral conversion of A (50 percent). Daily production rates are in the range of 0.1 to 0.4 mg/day and circulating levels are between 0.2 and 0.7 ng/mL with the lowest levels found during the early follicular phase followed by a 20 percent increase at midcycle . Nearly all (99 percent) of circulating T is protein-bound (mainly to sex-hormone binding globulin [SHBG]). Therefore, any impact on SHBG concentration (eg, oral estrogen-mediated increase in SHBG) affects the concentration of the free/active androgen. Lastly, DHT is mainly a peripheral product of T conversion and has very low circulating levels .
All the major androgens are metabolized and excreted into the urine almost exclusively as 17-ketosteroids.
Putative roles for androgens — Androgens are essential precursors for estrogen synthesis. They also play an important role in follicular development. Maintenance of a precise balance of estrogens and androgens within ovarian follicles is a requirement for successful follicular maturation. In addition, many tissues have androgen receptors, including the central nervous system and bone , which has led to speculation that androgens affect their function.
It has also been proposed that androgens play a role in sexual behavior. A woman's libido is dependent upon many factors, including psychological factors . A balance of estrogen and androgen also may be necessary for normal sexual desire and responsiveness. The results of studies on the role of androgens in sexuality in normal premenopausal women are inconclusive . However, the special case of adrenal insufficiency may be an exception, as data suggests that young women with this condition may show improvement in sexuality with the addition of DHEA to their replacement regimen.
Androgens may also be important for the maintenance of normal affect, cognitive functioning and of skeletal homeostasis. Regarding the latter, a significant body of evidence exists implicating a role for androgens in the maintenance of bone health. Androgens may impact bone homeostasis directly (eg, all bone cells including osteoblasts, osteoclasts, and osteocytes have androgen receptors), or indirectly by conversion to estrogen, or by their effect on local and systemic factors that control the bone cells' microenvironment .
Low serum androgen concentrations may be associated with lower bone density and fracture risk: Serum free androgen concentrations and bone mineral density have been positively correlated in several studies . In another study, postmenopausal women with a history of vertebral crush fractures had lower serum free androgen concentrations (and similar serum estrogen values) when compared to women with no fractures . Women with hypopituitarism (who are androgen deficiency) have low bone density .
Member Comments (1)
by goaannie, May 06, 2008 05:29PM
A related discussion, onset of menopause dhea and complex cyst was started.
