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Strac DS, Konjevod M, Perkovic MN, Tudor L, Erjavec GN, Pivac N. Dehydroepiandrosterone (DHEA) and its Sulphate (DHEAS) in Alzheimer's Disease. Curr Alzheimer Res 2020; 17:141-157. [PMID: 32183671 DOI: 10.2174/1567205017666200317092310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Neurosteroids Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone Sulphate (DHEAS) are involved in many important brain functions, including neuronal plasticity and survival, cognition and behavior, demonstrating preventive and therapeutic potential in different neuropsychiatric and neurodegenerative disorders, including Alzheimer's disease. OBJECTIVE The aim of the article was to provide a comprehensive overview of the literature on the involvement of DHEA and DHEAS in Alzheimer's disease. METHODS PubMed and MEDLINE databases were searched for relevant literature. The articles were selected considering their titles and abstracts. In the selected full texts, lists of references were searched manually for additional articles. RESULTS We performed a systematic review of the studies investigating the role of DHEA and DHEAS in various in vitro and animal models, as well as in patients with Alzheimer's disease, and provided a comprehensive discussion on their potential preventive and therapeutic applications. CONCLUSION Despite mixed results, the findings of various preclinical studies are generally supportive of the involvement of DHEA and DHEAS in the pathophysiology of Alzheimer's disease, showing some promise for potential benefits of these neurosteroids in the prevention and treatment. However, so far small clinical trials brought little evidence to support their therapy in AD. Therefore, large-scale human studies are needed to elucidate the specific effects of DHEA and DHEAS and their mechanisms of action, prior to their applications in clinical practice.
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Affiliation(s)
- Dubravka S Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Matea N Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Gordana N Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
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Corriger A, Duclos M, Corcuff JB, Lambert C, Marceau G, Sapin V, Macian N, Roux D, Pereira B, Pickering G. Hormonal Status and Cognitivo-Emotional Profile in Real-Life Patients With Neuropathic Pain: A Case Control Study. Pain Pract 2019; 19:703-714. [PMID: 31127700 DOI: 10.1111/papr.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The specific impact of neuropathic pain and recommended neuropathic pain treatments on the hormonal and immune status of patients has been so far poorly explored. This study aimed at studying, in real life, the hypothalamic-pituitary-adrenal axis and the cytokine profile of patients with neuropathic pain. It also explored their links with cognition, emotion, quality of life, and drug treatment. METHODS This prospective study (clinicaltrials.gov NCT01543425) included 60 patients with neuropathic pain and 60 age- and gender-matched healthy volunteers after obtaining signatures of informed consent. A number of parameters were measured: adrenocorticotropic hormone, cortisol, cortisol awakening response, dehydroepiandrosterone sulphate, sex hormone binding globulin, testosterone, 17-β-estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, cytokines, brain-derived neurotrophic factor, and vitamin D. Psychological parameters were assessed by questionnaires. RESULTS Patients with neuropathic pain had lower levels of adrenocorticotropic hormone (P = 0.009) and dehydroepiandrosterone sulphate (P < 0.001) than controls, and the cortisol awakening response was impaired. Patients were more depressed and anxious (P < 0.001) and had a diminished quality of life (P < 0.001), which was influenced by cytokines (P = 0.0067) and testosterone (P = 0.028). Antidepressants and antiepileptics appeared to interfere with testosterone and cognitivo-emotional domains. CONCLUSION An impairment of the hormonal status and of the immune system was observed in patients. It identified testosterone as a potential pivotal mediator between antidepressants/antiepileptics and quality of life. Further studies must address the exact impact of different types of drugs on central effects, of gender differences, and of the immune system of neuropathic pain.
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Affiliation(s)
- Alexandrine Corriger
- Laboratoire Neuro-Dol Inserm 1107, University Clermont Auvergne, Clermont-Ferrand, France
| | - Martine Duclos
- Sports Medicine Department, University Hospital, CHU, INRA UMR 1019, UNH, CRNH, Clermont-Ferrand, France
| | - Jean-Benoit Corcuff
- Hormone Laboratory, Nuclear Medicine, CHU Bordeaux UMR INRA 1286 - University Bordeaux, Bordeaux, France
| | - Céline Lambert
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Geoffroy Marceau
- Biochemistry Department, University Hospital CHU, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry Department, University Hospital CHU, Clermont-Ferrand, France
| | - Nicolas Macian
- Clinical Pharmacology Department, CPC/CIC Inserm 1405, University Hospital CHU, Clermont-Ferrand, France
| | - Delphine Roux
- Clinical Pharmacology Department, CPC/CIC Inserm 1405, University Hospital CHU, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Gisèle Pickering
- Laboratoire Neuro-Dol Inserm 1107, University Clermont Auvergne, Clermont-Ferrand, France.,Clinical Pharmacology Department, CPC/CIC Inserm 1405, University Hospital CHU, Clermont-Ferrand, France
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Sadaie MR, Farhoudi M, Zamanlu M, Aghamohammadzadeh N, Amouzegar A, Rosenbaum RE, Thomas GA. What does the research say about androgen use and cerebrovascular events? Ther Adv Drug Saf 2018; 9:439-455. [PMID: 30364888 DOI: 10.1177/2042098618773318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/29/2018] [Indexed: 12/21/2022] Open
Abstract
Many studies have investigated the benefits of androgen therapy and neurosteroids in aging men, while concerns remain about the potential associations of exogenous steroids and incidents of cerebrovascular events and ischemic stroke (IS). Testosterone is neuroprotective, neurotrophic and a potent stimulator of neuroplasticity. These benefits are mediated primarily through conversion of a small amount of testosterone to estradiol by the catalytic activity of estrogen synthetase (aromatase cytochrome P450 enzyme). New studies suggest that abnormal serum levels of the nonaromatized potent metabolite of testosterone, either high or low dihydrotestosterone (DHT), is a risk factor for stroke. Associations between pharmacologic androgen use and the incidence of IS are questionable, because a significant portion of testosterone is converted to DHT. There is also insufficient evidence to reject a causal relationship between the pro-testosterone adrenal androgens and incidence of IS. Moreover, vascular intima-media thickness, which is a predictor of stroke and myocardial symptoms, has correlations with sex hormones. Current diagnostic and treatment criteria for androgen therapy for cerebrovascular complications are unclear. Confounding variables, including genetic and metabolic alterations of the key enzymes of steroidogenesis, ought to be considered. Information extracted from pharmacogenetic testing may aid in expounding the protective-destructive properties of neurosteroids, as well as the prognosis of androgen therapy, in particular their cerebrovascular outcomes. This investigative review article addresses relevant findings of the clinical and experimental investigations of androgen therapy, emphasizes the significance of genetic testing of androgen responsiveness towards individualized therapy in post-IS injuries as well as identifying pertinent questions.
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Affiliation(s)
| | - Mehdi Farhoudi
- Neurosciences Research Center (NSRC), Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masumeh Zamanlu
- Neurosciences Research Center (NSRC), Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasser Aghamohammadzadeh
- Department of Endocrinology, Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gary A Thomas
- Penn State Hershey Neurology, Penn State University, PA, USA
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Yue XH, Tong JQ, Wang ZJ, Zhang J, Liu X, Liu XJ, Cai HY, Qi JS. Steroid sulfatase inhibitor DU-14 protects spatial memory and synaptic plasticity from disruption by amyloid β protein in male rats. Horm Behav 2016; 83:83-92. [PMID: 27222435 DOI: 10.1016/j.yhbeh.2016.05.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 05/16/2016] [Accepted: 05/19/2016] [Indexed: 02/01/2023]
Abstract
Alzheimer's disease (AD) is an age-related mental disorder characterized by progressive loss of memory and multiple cognitive impairments. The overproduction and aggregation of Amyloid β protein (Aβ) in the brain, especially in the hippocampus, are closely involved in the memory loss in the patients with AD. Accumulating evidence indicates that the Aβ-induced imbalance of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) in the brain plays an important role in the AD pathogenesis and progression. The level of DHEA is elevated, while DHEAS is dramatically decreased in the AD brain. The present study tried to restore the balance between DHEA and DHEAS by using a non-steroidal sulfatase inhibitor DU-14, which increases endogenous DHEAS through preventing DHEAS converted back into DHEA. We found that: (1) DU-14 effectively attenuated the Aβ1-42-induced cognitive deficits in spatial learning and memory of rats in Morris water maze test; (2) DU-14 prevented Aβ1-42-induced decrease in the cholinergic theta rhythm of hippocampal local field potential (LFP) in the CA1 region; (3) DU-14 protected hippocampal synaptic plasticity against Aβ1-42-induced suppression of long term potentiation (LTP). These results provide evidence for the neuroprotective action of DU-14 against neurotoxic Aβ, suggesting that up-regulation of endogenous DHEAS by DU-14 could be beneficial to the alleviation of Aβ-induced impairments in spatial memory and synaptic plasticity.
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Affiliation(s)
- Xing-Hua Yue
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan 030001, PR China; Department of Clinical Laboratory, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300100, PR China
| | - Jia-Qing Tong
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan 030001, PR China
| | - Zhao-Jun Wang
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan 030001, PR China
| | - Jun Zhang
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan 030001, PR China
| | - Xu Liu
- Department of Clinical Laboratory, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300100, PR China
| | - Xiao-Jie Liu
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Hong-Yan Cai
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan 030001, PR China
| | - Jin-Shun Qi
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan 030001, PR China.
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Taylor MK, Kviatkovsky SA, Hernández LM, Sargent P, Segal S, Granger DA. Anabolic hormone profiles in elite military men. Steroids 2016; 110:41-48. [PMID: 27083310 DOI: 10.1016/j.steroids.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 01/26/2023]
Abstract
We recently characterized the awakening responses and daily profiles of the catabolic stress hormone cortisol in elite military men. Anabolic hormones follow a similar daily pattern and may counteract the catabolic effects of cortisol. This companion report is the first to characterize daily profiles of anabolic hormones dehydroepiandrosterone (DHEA) and testosterone in this population. Overall, the men in this study displayed anabolic hormone profiles comparable to that of healthy, athletic populations. Consistent with the cortisol findings in our prior report, summary parameters of magnitude (hormone output) within the first hour after awakening displayed superior stability versus summary parameters of pattern for both DHEA (r range: 0.77-0.82) and testosterone (r range: 0.62-0.69). Summary parameters of evening function were stable for the two hormones (both p<0.001), while the absolute decrease in testosterone across the day was a stable proxy of diurnal function (p<0.001). Removal of noncompliant subjects did not appreciably affect concentration estimates for either hormone at any time point, nor did it alter the repeatability of any summary parameter. The first of its kind, this report enables accurate estimations of anabolic balance and resultant effects upon health and human performance in this highly resilient yet chronically stressed population.
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Affiliation(s)
- Marcus K Taylor
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, United States; Department of Exercise and Nutritional Sciences, San Diego State University, ENS Building, Room 351, 5500 Campanile Drive, San Diego, CA 92182, United States; Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, 550 E. Orange Street, Tempe, AZ 85287, United States.
| | - Shiloah A Kviatkovsky
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, United States
| | - Lisa M Hernández
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, United States; Department of Exercise and Nutritional Sciences, San Diego State University, ENS Building, Room 351, 5500 Campanile Drive, San Diego, CA 92182, United States
| | - Paul Sargent
- Naval Special Warfare Group ONE, 3632 Guadalcanal Road, Building 165, San Diego, CA 92155, United States
| | - Sabrina Segal
- Department of Psychology, Arizona State University, 550 E. Orange Street, Tempe, AZ 85287, United States
| | - Douglas A Granger
- Johns Hopkins School of Nursing and Bloomberg School of Public Health, 3400 North Charles Street, Baltimore, MD 21218, United States; Institute for Interdisciplinary Salivary Bioscience, University of California - Irvine, Irvine, CA 92697, United States; Salivary Bioscience Laboratory and Department of Psychology, University of Nebraska, 1400 R. Street, Lincoln, NE, United States
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Svob Strac D, Vlainic J, Samardzic J, Erhardt J, Krsnik Z. Effects of acute and chronic administration of neurosteroid dehydroepiandrosterone sulfate on neuronal excitability in mice. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1201-15. [PMID: 27051273 PMCID: PMC4807895 DOI: 10.2147/dddt.s102102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Neurosteroid dehydroepiandrosterone sulfate (DHEAS) has been associated with important brain functions, including neuronal survival, memory, and behavior, showing therapeutic potential in various neuropsychiatric and cognitive disorders. However, the antagonistic effects of DHEAS on γ-amino-butyric acidA receptors and its facilitatory action on glutamatergic neurotransmission might lead to enhanced brain excitability and seizures and thus limit DHEAS therapeutic applications. The aim of this study was to investigate possible age and sex differences in the neuronal excitability of the mice following acute and chronic DHEAS administration. Methods DHEAS was administered intraperitoneally in male and female adult and old mice either acutely or repeatedly once daily for 4 weeks in a 10 mg/kg dose. To investigate the potential proconvulsant properties of DHEAS, we studied the effects of acute and chronic DHEAS treatment on picrotoxin-, pentylentetrazole-, and N-methyl-D-aspartate-induced seizures in mice. The effects of acute and chronic DHEAS administration on the locomotor activity, motor coordination, and body weight of the mice were also studied. We also investigated the effects of DHEAS treatment on [3H]flunitrazepam binding to the mouse brain membranes. Results DHEAS did not modify the locomotor activity, motor coordination, body weight, and brain [3H]flunitrazepam binding of male and female mice. The results failed to demonstrate significant effects of single- and long-term DHEAS treatment on the convulsive susceptibility in both adult and aged mice of both sexes. However, small but significant changes regarding sex differences in the susceptibility to seizures were observed following DHEAS administration to mice. Conclusion Although our findings suggest that DHEAS treatment might be safe for various potential therapeutic applications in adult as well as in old age, they also support subtle interaction of DHEAS with male and female hormonal status, which may underline observed sex differences in the relationship between DHEAS and various health outcomes.
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Affiliation(s)
- Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Josipa Vlainic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Janko Samardzic
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Julija Erhardt
- Department of Animal Physiology, Faculty of Science, University of Zagreb
| | - Zeljka Krsnik
- Croatian Institute for Brain Research, Department of Neuroscience, School of Medicine, University of Zagreb, Zagreb, Croatia
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8
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The Authors Reply. Psychosom Med 2016; 78:116-7. [PMID: 26705071 DOI: 10.1097/psy.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Taylor MK, Carpenter J, Stone M, Hernandez LM, Rauh MJ, Laurent HK, Granger DA. Genetic and environmental modulation of neurotrophic and anabolic stress response: Counterbalancing forces. Physiol Behav 2015; 151:1-8. [PMID: 26136163 DOI: 10.1016/j.physbeh.2015.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 05/27/2015] [Accepted: 06/20/2015] [Indexed: 11/20/2022]
Abstract
The serotonin transporter genetic variant 5HTTLPR influences activation and feedback control of the hypothalamic-pituitary-adrenal axis, and has been shown to influence the effect of stressful life events on behavioral health. We recently reported that 5HTTLPR modulates cortisol response in healthy military men exposed to intense stress. Less is known of its combined effects with environmental factors in this context, or of its effect on neuroprotective stress responses. In this follow-up study, we examined the unique and combined effects of 5HTTLPR and prior trauma exposure on neuroprotective (salivary nerve growth factor [sNGF]), anabolic (dehydroepiandrosterone sulfate [DHEAS] and testosterone), and catabolic (cortisol) stress responses. Ninety-three healthy, active-duty military men were studied before, during, and 24h after a stressful 12-day survival course. Distinct and interactive effects of 5HTTLPR long allele carriage [L] versus homozygous short allele carriage [SS]) and prior trauma exposure (low versus high) were evaluated, after which a priori group comparisons were performed between hypothesized high resilience (L/low) and low resilience (SS/high) groups. For sNGF, L/low produced the greatest sNGF throughout stress exposure while SS/high demonstrated the smallest; L/high and SS/low bisected these two extremes and were nearly identical to each other (i.e., SS/high < SS/low = L/high < L/low). Thus, 5HTTLPR and prior trauma exposure demonstrated counterbalancing (additive) forces. Similar patterns were found for DHEAS. To our knowledge, this study is the first to report counterbalancing genetic and environmental effects on novel biomarkers related to resilience in humans exposed to real-world stress. These findings have profound implications for health, performance and training in high-stress occupational settings.
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Affiliation(s)
- Marcus K Taylor
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA; School of Exercise and Nutritional Sciences, San Diego State University, ENS Building Room 351, 5500 Campanile Drive, San Diego, CA, USA; Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, 550 E. Orange Street, Tempe, AZ, USA.
| | - Jennifer Carpenter
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA; School of Exercise and Nutritional Sciences, San Diego State University, ENS Building Room 351, 5500 Campanile Drive, San Diego, CA, USA.
| | - Michael Stone
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA; School of Exercise and Nutritional Sciences, San Diego State University, ENS Building Room 351, 5500 Campanile Drive, San Diego, CA, USA.
| | - Lisa M Hernandez
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA; School of Exercise and Nutritional Sciences, San Diego State University, ENS Building Room 351, 5500 Campanile Drive, San Diego, CA, USA.
| | - Mitchell J Rauh
- Biobehavioral Sciences Lab, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA; School of Exercise and Nutritional Sciences, San Diego State University, ENS Building Room 351, 5500 Campanile Drive, San Diego, CA, USA.
| | - Heidemarie K Laurent
- Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, 550 E. Orange Street, Tempe, AZ, USA; Department of Psychology, 1227 University of Oregon, Eugene, OR, USA.
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, Arizona State University, 550 E. Orange Street, Tempe, AZ, USA; Johns Hopkins School of Nursing and Bloomberg School of Public Health, 3400 North Charles Street, Baltimore, MD, USA.
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Abstract
Although dehydroepiandrosterone (DHEA) and its sulphate ester dehydroepiandrosterone sulphate (DHEAS) are the most abundant steroid hormones in the human circulation, its exact physiological role is not yet fully understood. In patients with adrenal insufficiency, secretion of DHEA is impaired, leading to decreased circulating DHEA and DHEAS levels, and to androgen deficiency in women. Replacement of DHEA in patients with adrenal insufficiency positively influence mood, sexuality and subjective health status. These effects are generally moderate and show high inter-individual variability. Limited evidence exists for immunomodulatory effects of DHEA. Although an increase of IGF-I levels has been documented, relevant effects on body composition, metabolic or cardiovascular parameters has not been observed in patients with adrenal insufficiency receiving DHEA. Larger-scale phase III studies are still lacking; therefore, initiation of DHEA replacement is decided on an individual basis, focussing on those patients with impaired well-being associated with signs and symptoms of androgen deficiency.
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Affiliation(s)
- Katharina Lang
- Endocrinology and Diabetes Unit, Department of Internal Medicine I, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, D-97080 Wuerzburg, Germany.
| | - Stephanie Burger-Stritt
- Endocrinology and Diabetes Unit, Department of Internal Medicine I, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, D-97080 Wuerzburg, Germany.
| | - Stefanie Hahner
- Endocrinology and Diabetes Unit, Department of Internal Medicine I, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, D-97080 Wuerzburg, Germany.
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