Relationship between androgen deficiency and memory impairment in aging and Alzheimer’s disease

Aging and Alzheimer’s disease (AD) are associated with a declination of cognition and memory, whose severity increases in AD. Recent investigations point to a greater participation of neurofibrillary tangles (NFTs) than that of senile plaques, as responsible for cognitive impairment in AD and normal aging. On the other hand, aging is related with reduced levels of dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) as well as testosterone (T). Basic and clinical studies give evidence that hypoandrogenism is associated with memory impairment. Accordingly, some animal studies show that the administration of these hormones improves the performance of cognitive tasks. However, effects of DHEA, DHEA-S, and T in the clinical setting, are not clear in part because of the balance between the benefits and risks of hormone therapy in aging subjects and because the cellular mechanism underlying its effects on memory in old age and related pathologies are unknown. The objective of this review is to analyze the role of DHEA, DHEA-S, and T, on memory in normal aging and in AD, and to determine whether these hormones modulate the hyperphosphorylation of tau protein, a molecular marker in AD pathology. The method used in the review included articles from the PubMed database, using the following search terms: DHEA, DHEA-S, T, memory, androgen deprivation therapy, tau protein, aging, and AD. Finally, we analyze the use of these steroids as an adjunct in the treatment of memory deficits in aging subjects and AD patients.

[Hormonal deficiencies in the elderly: is there a role for replacement therapy?]

Biological aging is characterized by a progressive loss of the secretion of various hormones, a phenomenon that leads some physicians to propose an anti-aging hormonal therapy. It is mandatory to differentiate: 1) the physiological functional loss, which is a natural phenomenon without clear deleterious consequences on health and should not be compensated by the administration of hormones only to restore plasma levels similar to those measured in young people and 2) a pathological defect that deserves a replacement therapy to correct the endocrine deficiency and improve the health status of older individuals. This article considers the deficiencies in insulin, thyroid hormones, growth hormone, dehydroepiandrosterone (DHEA) and testosterone. For each hormone, a benefit/risk ratio of a so-called replacement therapy will be analyzed.

Androgen deficiency in long-term intrathecal opioid administration

BACKGROUND

Intrathecal drug delivery of opioids is an efficient and effective treatment option for pain management in the chronic nonmalignant pain population. As with all treatments, in addition to the benefits, risks and side effects exist. One such risk in intrathecal opioids is opioid-induced androgen deficiency.

OBJECTIVE

This study evaluates opioid-induced androgen deficiency in long-term intrathecal opioid administration in chronic nonmalignant pain.

STUDY DESIGN

Case series. Sixteen consecutive patients with intrathecal drug delivery with opioids were screened for androgen deficiency.

SETTING

Academic university-based pain management center.

METHOD

All the subjects were seen in a 2 month period, during a scheduled maintenance refill visit. Eight consecutive men and eight consecutive women receiving intrathecal drug delivery therapy for non-malignant chronic pain were ordered blood work and asked to complete a questionnaire. Patient and patient-related data were also collected.

RESULTS

Ten of the 16 (62.5%) patients were found to have androgen deficiency, 4 of 8 men based on free testosterone levels and 6 of 8 women based on DHEA levels. In men, erectile dysfunction correlated with endocrine dysfunction (P = 0.02) while depressive symptoms correlated in women (P = .03). Overall, 2 of the 16 patients had hydromorphone as the opioid in the intrathecal system. Both patients had normal endocrine functions. Both patients with hydromorphone were men and the use of hydromorphone showed an insignificant trend (P = 0.06). Three of the 4 men with normal endocrine functions had in addition to an opioid, bupivacaine, in the intrathecal system. The presence of bupivicaine in men was significant (P = 0.02). No women had bupivicaine while one of the 8 women had clonidine in addition to the opioid. Presence of another substance in addition to the opioid showed an insignificant trend (P = 0.08).

LIMITATIONS

Study limitations include the small sample size and case series nature. Additionally the symptoms data was solely based on subjective patient reports.

CONCLUSIONS

Androgen deficiency is common in patients treated with intrathecal opioids for chronic nonmalignant pain. Patients experience numerous and wide ranging symptoms. Erectile dysfunction may be more suggestive for androgen deficiency in men while complaints of depressed mood may be correlative in women. Additionally, combining bupivicaine with the intrathecal opioid may provide a protective role.

Anabolic status and functional impairment in men with mild chronic heart failure

The purpose of this study was to establish the role of hormonal anabolic deficiencies in exercise intolerance in patients with chronic heart failure One hundred four consecutive men (mean age 53.1 ± 10.6 years) with established diagnoses of chronic heart failure were included. At enrollment, blood samples were taken, and echocardiography and cardiopulmonary exercise testing were carried out. Exercise capacity was expressed as peak oxygen consumption (Vo₂), predicted peak Vo₂, and the ventilatory response to exercise (VE/Vco₂) slope. The mean left ventricular ejection fraction was 29.7 ± 11.9%, and most patients (86%) were in New York Heart Association class I or II, with a mean peak Vo₂ of 18 ml/min/kg. According to the age-adjusted reference values, hormonal deficiencies were present in 29% for total testosterone, 39% for estimated free testosterone, 34% for insulin-like growth factor-1, and 61% for dehydroepiandrosterone sulfate. Dehydroepiandrosterone sulfate showed a significant correlation with peak Vo₂ (r = 0.29, p = 0.007), predicted peak Vo₂ (r = 0.28, p = 0.006), and VE/Vco₂ slope (r = -0.39, p <0.001), whereas total testosterone, estimated free testosterone, and insulin-like growth factor-1 were not significantly correlated. After adjusting in a multivariable model, dehydroepiandrosterone sulfate remained an independent predictor of each exercise parameter. In conclusion, in a cohort of patients with mild chronic heart failure, exercise capacity objectively measured using cardiopulmonary exercise testing was related to anabolic impairment of the adrenal rather than the somatotropic or peripheral axis.

Adrenal insufficiency: etiology, diagnosis and treatment

PURPOSE OF REVIEW

Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2010 because of its lethal nature.

RECENT FINDINGS

Reports illuminate features of adrenal insufficiency cause, diagnosis and treatment, and the role of glucocorticoids in critical illness.

SUMMARY

Progress has been made in identifying human leukocyte antigen and major histocompatability complex alleles that predispose to the development of adrenal insufficiency in patients with antibodies to 21-hydroxylase, but their role in clinical care is not established. Reports of HIV-associated infections and medication-induced hypocortisolism are reminders that autoimmune adrenal destruction does not underlie all cases. The diagnosis is adequately established by the 250 microg adrenocortocotropin hormone stimulation test in most patients; the 1 microg test carries the risk of misdiagnosis of healthy individuals as adrenally insufficient. Glucocorticoids provide life-saving treatment, but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. The current recommended total daily dose is lower than that often prescribed. Dehydroepiandrosterone replacement may be useful in pubertal girls with hypopituitarism, but not in adults. Supraphysiologic hydrocortisone doses may aid in the reversal of septic shock independent of underlying adrenal function.

[Hormone replacement Up-to-date. Adrenopause and DHEA replacement therapy]

It is well known that serum levels of DHEA and its sulfate form DHEA-S decline along with aging. This phenomenon is called adrenopause in contrast to menopause. Experimental studies show that DHEA has many beneficial effects such as anti-diabetic, anti-atherosclerosis, and anti-osteoporosis effects. Therefore, DHEA replacement has been performed as anti-aging therapy. Several clinical trials of DHEA replacement demonstrated the improvement of sense of well-being, lipid metabolism, and bone metabolism. We recently reported on the result of short-term administration of DHEA in healthy Japanese volunteer men. It is thought that further accumulation of original data is necessary to promote DHEA replacement therapy in Japan.

Effects of dehydroepiandrosterone replacement therapy on bone mineral density in older adults: a randomized, controlled trial

CONTEXT

Dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) decrease with aging and are important androgen and estrogen precursors in older adults. Declines in DHEAS with aging may contribute to physiological changes that are sex hormone dependent.

OBJECTIVE

The aim was to determine whether DHEA replacement increases bone mineral density (BMD) and fat-free mass.

DESIGN, SETTING, AND PARTICIPANTS

A randomized, double-blinded, controlled trial was conducted at an academic research institution. Participants were 70 women and 70 men, aged 60-88 yr, with low serum DHEAS levels.

INTERVENTION

The intervention was oral DHEA 50 mg/d or placebo for 12 months.

MEASUREMENTS

BMD, fat mass, and fat-free mass were measured before and after intervention.

RESULTS

Intent-to-treat analyses revealed trends for DHEA to increase BMD more than placebo at the total hip (1.0%, P = 0.05), trochanter (1.2%, P = 0.06), and shaft (1.2%, P = 0.05). In women only, DHEA increased lumbar spine BMD (2.2%, P = 0.04; sex-by-treatment interaction, P = 0.05). In secondary compliance analyses, BMD increases in hip regions were significant (1.2-1.6%; all P < 0.02) in the DHEA group. There were no significant effects of DHEA on fat or fat-free mass in intent-to-treat or compliance analyses.

CONCLUSIONS

DHEA replacement therapy for 1 yr improved hip BMD in older adults and spine BMD in older women. Because there have been few randomized, controlled trials of the effects of DHEA therapy, these findings support the need for further investigations of the benefits and risks of DHEA replacement and the mechanisms for its actions.

Dehydroepiandrosterone Therapy as Female Androgen Replacement

Dehydroepiandrosterone (DHEA) is an abundant circulating androgen precursor preferentially produced by the adrenal glands. DHEA has been shown to exert its effects via downstream conversion to sex steroid hormones, neuromodulation, improvement in endothelial cell function, and possibly by acting on a cell membrane-bound receptor. Low levels of circulating DHEA have been demonstrated in women with diminished libido and other symptoms of sexual dysfunction. DHEA deficiency has also been associated with various drugs, and endocrine, nonhormonal, and age-related disorders. DHEA supplementation has been shown to produce beneficial effects in women with adrenal insufficiency. However, DHEA supplementation in healthy euadrenal subjects (including premenopausal and postmenopausal women with androgen insufficiency) is controversial; studies have yielded conflicting results regarding its beneficial effects on sexual function, metabolism, and overall well-being. Further research is needed to better elucidate the efficacy and safety of DHEA supplementation for the treatment of androgen insufficiency in women.

[Replacement and supplementation of DHEA--is it a wellness hormone?]

DHEA is an adrenal steroid hormone, the physiological role of which is largely unknown. Since the DHEA/DHEAS levels decrease appreciably with age in most people, DHEA is often considered to have a role to play in the aging process, and its use as an anti-aging or wellness hormone to diminish age-related complaints is often propagated. Studies on this are, however, meager. Currently, there is no definitive indication for DHEA supplementation in persons with low DHEA levels. In adrenal cortex insufficiency in contrast, there is an absolute DHEA deficiency. In women suffering from Addisons's disease or pituitary insufficiency with high-grade DHEA and androgen deficiency, however, substitution makes good pathophysiological sense, and treatment can be useful.

Hormontherapie des alternden Mannes

The endocrine system of aging males reveals changes of more or less unknown significance for estrogens, dehydroepiandrosterone (DHEA), melatonin and growth hormone. The difference between physiological changes and clear hormone deficiency is not really understood and the clinical relevance of the observed changes needs to be investigated. Estrogens do not show any changes, but DHEA, melatonin or growth hormone show several changes in their concentrations concomitant with increasing age, without validated clinical significance. According to the guidelines of the ISSAM, the significance of changes in DHEA, DHEAS, melatonin, growth hormone and IGF-1 are not well enough understood to justify routine examination when investigating late-onset hypogonadism in aging men. There is no indication for treatment with these hormones (with the exception of, e.g., estrogens in prostate cancer or male-to-female-transsexualism), as the assumed positive effects as well as negative side effects are not clearly understood and need further investigation.

[Intrinsic skin aging. A critical appraisal of the role of hormones]

Intrinsic skin aging is determined primarily by genetic factors and hormonal status. It reflects the same degenerative process seen in other organs. Skin function is one of the parameters most influenced by aging. The hormonal influences include reduced pituitary, adrenal and gonadal secretion. The hormonal changes of aging lead to the development of a specific body and skin phenotype. Individuals in developed lands spend up to a third of their life (women-post-menopausal) or perhaps 20 years (men-partial androgen deficiency of the aging man, PADAM) with oestrogen or androgen deficiency. Other hormones whose levels decrease with aging include melatonin, growth hormone (GH), dehydroepiandrosterone und insulin-like growth factor-I (IGF-I). Since the skin not only fulfils a protective function for the organism but is also an active peripheral endocrine organ, which even releases effective hormones in the circulation, local hormone substitution could become interesting in the future.

[Adrenopause and dehydroepiandrosterone: pharmacological therapy versus replacement therapy]

BACKGROUND

Adrenopause is an age-related, partial insufficiency of the adrenal cortex characterized by its low blood levels of dehydro-epiandrosterone (DHEA) and DHEA sulfate (DS) in the presence of undiminished cortisol levels. A great number of effects in the CNS and in the periphery are known, partially due to DHEA as an independent hormone, partially due to its influence as a precursor of sex hormones. Positive epidemiological data about DHEA on morbidity and mortality in males as well as clinical reports about promising effects of a DHEA supplementation in elderly people suggest that controlled replacement therapy might be useful in the prevention and treatment of degenerative processes in humans. In studies sofar a fixed daily DHEA dose of 50-100 mg in men and 25-50 mg in women was used irrespective of the individual extent of the adreno-pause. This regimen raised serum levels of DS to and mostly above the upper normal range, thus leading to pharmacological effects.

PATIENTS AND METHODS

We report about our experiences in DHEA dose finding in 100 men and 100 women with adrenopause, aged between 46 and 74 years, over a period of 6-12 weeks in order to find a suitable daily oral DHEA dose. The aim was to raise the daily DS peak level between 3 and 5 h after the intake in the morning to 2.0-2.8 pg/ml in women and 4.0-5.0 gg/ml in males, levels that are thought to be in the optimal range of healthy adults in the third decennium of their life (controls).

RESULTS

There were 5, 10, 15, 25 or 50 mg DHEA in 18, 26, 34, 19 or 3% of the women and 15, 25, 50, 75 or 100 mg DHEA in 5, 13, 51, 17 or 14% of the males suitable for that purpose. This adjusted dose regimen raised serum levels (mean values +/- SD) significantly (p < 0.01): (a) in women in the case of DS from 0.7 +/- 0.4 to 2.4 + 0.5 microg/ml, free testosterone from 0.4 +/- 0.4 to 0.9 +/- 0.5 pg/ml and androstenedione from 0.8 +/- 0.4 to 1.4 +0.4 ng/ml, and (b) in males in the case of DS from 1.4 +/- 0.5 to 4.1 +0.7 microg/ml, free testosterone from 10.9 + 4.1 to 14.7 +/- 4.5 pg/ml,androstenedione from 1.2 +/- 0.5 to 2.0 +/- 0.6 ng/ml, estrone from 28 +/- 14 to 41 +/- 19 pg/ml and estradiol from 16 +/- 8 to 31 +/- 15 pg/ml. In cases of inadequate dosage there were side effects like sleepiness,restlessness, headache, acne/hirsutism, effluvium or odors in a percentage of 34, 17, 9, 31, 21 and 11% of the women, respectively.After having adjusted the individual dosage to meet the proper serum levels of DS, these side effects were significantly reduced (p <0.05; p < 0.2 in cases with headache) and found only in 8, 2, 4, 6, 7 and 0%, respectively. In males, such symptoms occurred only occasionally.

CONCLUSION

We suggest replacement therapy in cases of adrenopause with an "individually adjusted" low DHEA dose between 5 and 50 mg for women and 15 and 100 mg for men in order to raise DS peak levels into the physiological range of younger adults. This procedure has here been applied routinely for the last 5 years, leading to an excellent compliance of the patients. In contrast,a high-dose pharmacological DHEA administration seems to be suit-able for patients with systemic lupus erythematosus and other related diseases.

DHEA treatment: myth or reality?

Dehydroepiandrosterone (DHEA) and its sulfate ester are major secretory products of the human adrenal. Serum DHEA concentrations decline with advancing age and DHEA supplementation in elderly people has been advertized as anti-aging medication. However, such claims are based on experiments in rodents with a fundamentally different DHEA physiology. In humans, DHEA is a crucial precursor of sex steroid biosynthesis and exerts indirect endocrine and intracrine actions following conversion to androgens and estrogens. In addition, it acts as a neurosteroid via effects on neurotransmitter receptors in the brain. DHEA has considerable effects on mood, well-being and sexuality in patients with adrenal insufficiency, and also in those with mood disorders. However, subjects with a physiological, age-related decline in DHEA secretion show little benefit from DHEA administration. Future research should focus on DHEA treatment for adrenal insufficiency, and DHEA administration in both patients receiving chronic glucocorticoid treatment and women with androgen deficiency.

DHEA: the last elixir

(1) DHEA, or dehydroepiandrosterone, is an adrenal steroid. Its physiological role is unclear, but it is known to be an intermediate in sex hormone synthesis. DHEA replacement therapy is not currently indicated in adrenal insufficiency. (2) Plasma DHEA levels are so low in most animal species that they are difficult to measure, hindering studies of the impact of DHEA on ageing. Most animal studies are based on administration of pharmacological doses. (3) Clinical data have been obtained in a very large number of observational studies, in which plasma concentrations of DHEA were measured in various situations. The only established fact is that circulating concentrations show wide interpersonal variability and a tendency to fall with age. Low DHEA levels have not so far been linked to any specific health disorders. (4) Clinical trials of DHEA have focused on cognitive function, well-being, libido, immunostimulation, etc. There is no proof that DHEA is beneficial in these areas. (5) The side effects of DHEA are linked to its androgenic effects (acne, hirsutism), its unfavourable effects on lipid metabolism (a cardiovascular risk factor), and a possible growth-stimulating effect on hormone-dependent malignancies (prostate, breast). (6) In practice, there is currently no scientific reason to prescribe DHEA for any purpose whatsoever.

[DHEA: orthodox or alternative medicine?]

The exact physiological role of DHEA remains unknown but DHEA supplementation has recently been proven beneficial in typical deficient states like adrenal insufficiency or major depressive illlnesses. The putative favorable effects of DHEA in other conditions remain controversial. However, recent studies confirmed positive effects of DHEA administration in healthy elderly people, mostly more than 70 years old women, on skin, bone density, muscle strength and several neuropsychological symptoms. Positive effects on sexual interest and satisfaction and sense of well-being are more consistent in elderly women than in men. The recommended administered dose is 25 mg to 50 mg once a day in women and 100 mg in men. Androgenic side effects (greasy skin, acne, increased growth of body hair) are frequent but reversible side effects. Dose adaptation is recommended in these conditions. It is justifiable to prescribe DHEA in patients with adrenal insufficiency. Other possible indications are depression and prolonged glucocorticoid therapy. In elderly people, DHEA administration might be considered in DHEA depleted-patients with skin dryness or atrophy, muscle weakness, low bone density or neuropsychological symptoms. The treatment should be taken under close medical supervision in order to detect a possible hormone-dependent cancer such as breast cancer in women and prostatic cancer in men. The patients should be informed on the potential risks of DHEA administration and on the lack of definitive proven beneficial effects of DHEA, waiting the results of well-conducted controlled double blind prospective studies.

[Testosterone and dehydroepiandrosterone deficiency, general adiposity and visceral obesity during normal male aging]

Both clinical observations and in vitro studies reveal that sex steroids are essential factors affecting body fat accumulation and distribution of healthy men. An excessive adiposity and visceral obesity are frequently accompanied by an adrenal and gonadal andropenia among men aged 50 and over. The relationships between an age-related increase in BMI and WHR values and an altered androgen-estrogen activity in the course of normal male aging have not been firmly established, as not all studies have thus far produced consistent results. The effects of androgen substitutive therapy (testosterone and dehydroepiandrosterone) in elderly men suggest the possible relationship between androgens and male visceral adiposity; unfortunately the results of available studies on that issue are also not consistent. Therefore, nowadays there is an urgent need to comprehensively establish the androgen contribution in the pathogenesis of male visceral obesity.

[Neuropsychic effects of dehydroepiandrosterone]

Dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S) are secreted primarily by the adrenal glands. DHEA could also be a neuroactive steroidal hormone. Because basal levels of DHEA and DHEA-S in humans decrease significantly with age, these hormones have been assumed to be involved in the aging process and in a number of pathologies which develop with aging: immunosenescence, increased mortality, increased incidence of cancer, osteoporosis and cardiovascular diseases. However, its role is still unknown. In humans, cross sectional and longitudinal studies have shown that DHEA might be associated with global measures of well-being and functioning, but positive effects on measures of memory and attention could not be found. Studies investigating DHEA and DHEA-S levels in dementia have produced controversial results. Short-term experimental studies have not shown significant improvement in global measures of well-being and functioning in healthy subjects but have revealed preliminary evidence for mood enhancing and antidepressant effects of DHEA. There is no evidence that DHEA could induce addiction in human beings.

DHEA deficiency syndrome: a new term for old age?

Dehydroepiandrosterone (DHEA) is a steroid secreted by the adrenal cortex, with a characteristic, age-related, pattern of secretion. The decline of DHEA concentrations with age has led to the suggestion that old age represents a DHEA deficiency syndrome and that the effects of ageing can be counteracted by DHEA 'replacement therapy'. DHEA is increasingly being used in the USA, outside medical supervision, for its supposed anti-ageing effects. This commentary weighs the evidence for the existence of a DHEA deficiency syndrome and considers the value of DHEA 'replacement therapy'.

Dehydroepiandrosterone replacement in women with adrenal insufficiency

BACKGROUND

The physiologic role of dehydroepiandrosterone in humans is still unclear. Adrenal insufficiency leads to a deficiency of dehydroepiandrosterone; we therefore, investigated the effects of dehydroepiandrosterone replacement, in patients with adrenal insufficiency.

METHODS

In a double-blind study, 24 women with adrenal insufficiency received in random order 50 mg of dehydroepiandrosterone orally each morning for four months and placebo daily for four months, with a one-month washout period. We measured serum steroid hormones, insulin-like growth factor I, lipids, and sex hormone-binding globulin, and we evaluated well-being and sexuality with the use of validated psychological questionnaires and visual-analogue scales, respectively. The women were assessed before treatment, after one and four months of treatment with dehydroepiandrosterone, after one and four months of placebo, and one month after the end of the second treatment period.

RESULTS

Treatment with dehydroepiandrosterone raised the initially low serum concentrations of dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, and testosterone into the normal range; serum concentrations of sex hormone-binding globulin, total cholesterol, and high-density lipoprotein cholesterol decreased significantly. Dehydroepiandrosterone significantly improved overall well-being as well as scores for depression and anxiety. For the global severity index, the mean (+/-SD) change from base line was -0.18+/-0.29 after four months of dehydroepiandrosterone therapy, as compared with 0.03+/-0.29 after four months of placebo (P=0.02). As compared with placebo, dehydroepiandrosterone significantly increased the frequency of sexual thoughts (P=0.006), sexual interest (P=0.002), and satisfaction with both mental and physical aspects of sexuality (P=0.009 and P=0.02, respectively).

CONCLUSIONS

Dehydroepiandrosterone improves well-being and sexuality in women with adrenal insufficiency.

[Rejuvenating hormones]

The clinical and biological syndromes of menopause, andropause, somatopause and adrenopause are presented successively. Various substitutive hormonotherapies (including melatonin) are considered according to their efficacy, risks and cost.

The etiology of rheumatoid arthritis

The etiology of rheumatoid arthritis has been elusive, but it finally seems to be explained by a combination of three factors: (i) a relatively mild deficiency of cortisol, the normal adrenocortical hormone that is essential for normal immunity but which has achieved a bad reputation because of the use of excessive dosages of it or its stronger derivatives, (ii) a deficiency of dehydro-epi-androsterone (DHEA), the chief androgen produced by the human adrenal cortex but which has been little studied, and (iii) infection by organisms such as mycoplasma, which have a relatively low virulence, are difficult to culture in the laboratory, and cause inflammation and destruction of tissue in periarticular and articular areas of immunocompromised hosts. The mild adrenocortical deficiency apparently is sufficient to impair immunity, especially after stress, and permit these organisms to cause inflammatory arthritis. Further studies are necessary to determine optimum therapy, but it will probably include safe physiologic dosages of cortisol and DHEA plus antibiotic treatment of infection by mycoplasma or other causative organisms.

Serum dehydroepiandrosterone and DHEA-sulfate in patients with adult T-cell leukemia and human T-lymphotropic virus type I carriers

The serum levels of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) were determined by radioimmunoassay in 38 patients with adult T-cell leukemia (ATL). Levels of serum DHEA and DHEA-S were also measured in 60 human T-lymphotropic virus type I (HTLV-I) carriers, and did not differ from those in 60 healthy control subjects. Serum levels in patients with ATL were lower than those in the age- and sex-matched healthy controls and in HTLV-I carriers with statistical significance. Serum DHEA and DHEA-S in male patients with acute and lymphoma-type ATL were 1.06 +/- 0.77 ng/ml and 245.8 +/- 192.9 ng/ml, respectively. Levels in male patients with chronic and smoldering-type ATL were 1.69 +/- 0.68 ng/ml and 477.6 +/- 251.5 ng/ml, respectively. Serum levels of DHEA and DHEA-S in patients with acute and lymphoma-type ATL were significantly lower than those in patients with chronic and smoldering-type ATL (P < 0.05). These data suggest that a decrease in serum levels of DHEA and DHEA-S may be associated with patients who have some clinical subtypes of ATL. Moreover, androgens may have a therapeutic role in patients with ATL, as administered in patients with hairy-cell leukemia. Because there is at present no curative chemotherapy for ATL, a trial combination of androgens and standard chemotherapy may be a reasonable therapeutic option in such patients.

Dysregulation of IL-10 production with aging: possible linkage to the age-associated decline in DHEA and its sulfated derivative

Peripheral lymphoid cells isolated from the spleens and peritoneal cavities of aged mice were found to constitutively secrete the multifunctional cytokine interleukin (IL)-10 when cultured in vitro. B-Lymphocytes were implicated as the cell type responsible. Abnormal expression of this cytokine was also detected in vivo because high levels of mRNA for IL-10 were present in splenocytes freshly isolated from aged animals. In addition to the spontaneous secretion of IL-10, lymphoid cells from aged donors were hyperresponsive to exogenous stimulation with endotoxin, producing exaggerated quantities of both IL-10 and IL-6 in culture. Treatment of aged animals with dehydroepiandrosterone sulfate (DHEAS), a natural steroid, reversed the age-associated alterations in cytokine production, rendering the treated mice quite similar to mature adult controls. DHEAS treatment of aged mice also resulted in a lowering in the number of B1 cells present in the peritoneal cavity and also reduced the titers of circulating autoantibodies specific for phosphatidylcholine (PtC). Based on its wide range of biologic activities, a dysregulation in the mechanisms that control IL-10 production could be a major contributor to immunosenescence. The ability of DHEAS treatment to restore normal control over the expression of IL-10 may explain how this steroid enhances immunocompetence in aged animals.

A review of dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone (DHEA) is quantitatively the most abundant hormone in humans and mammals, with a wide variety of physiological effects, including major regulatory effects upon the immune system. Two of the most striking aspects of DHEA are a steady decline in DHEA with age and a significant deficiency in DHEA in patients with several major diseases, including cancer, atherosclerosis, and Alzheimer's disease. The hormone is secreted in a non-sulfated (DHEA) and sulfated form (DHEA-S). The two are apparently interchangeable, and it appears likely that its physiological effects are achieved by derivative molecules that have yet to be identified.

Low serum levels of dehydroepiandrosterone may cause deficient IL-2 production by lymphocytes in patients with systemic lupus erythematosus (SLE)

The principal cause of IL-2 deficiency, a common feature of both murine lupus and human SLE, remains obscure. Recent studies of our own as well as others have shown that dehydroepiandrosterone (DHEA), an intermediate compound in testosterone synthesis, significantly up-regulates IL-2 production of T cells, and that administration of exogenous DHEA or IL-2 via a vaccinia construct to murine lupus dramatically reverses their clinical autoimmune diseases. Thus, we have examined serum levels of DHEA in patients with SLE to test whether abnormal DHEA activity is associated with IL-2 deficiency of the patients. We found that nearly all of the patients examined have very low levels of serum DHEA. The decreased DHEA levels were not simply a reflection of a long term corticosteroid treatment which may cause adrenal atrophy, since serum samples drawn at the onset of disease, which are devoid of corticosteroid treatment, also contained low levels of DHEA. In addition, exogenous DHEA restored impaired IL-2 production of T cells from patients with SLE in vitro. These results indicate that defects of IL-2 synthesis of patients with SLE are at least in part due to the low DHEA activity in the serum.

Abnormal adrenal steroidogenesis in growth-retarded newborn infants

The results of prior studies suggest that abnormalities of development and function of the fetal adrenal occur in pregnancies complicated by intrauterine fetal growth retardation (IUGR). In the present investigation, we sought to extend such studies by matching IUGR infants with normally grown infants of women in whom pregnancy complications, delivery method, and gestational age were comparable. In 47 vaginally delivered, IUGR infants (38 +/- 2 wk, mean +/- SD; 2244 +/- 589 g body weight), the levels of dehydroepiandrosterone sulfate (DS) in umbilical cord serum (4.48 +/- 2.94 mumol/L) were lower (p = 0.035) than those (5.94 +/- 3.63 mumol/L) of 47 normal weight infants (38 +/- 2 wk; 3107 +/- 527 g). Yet, umbilical cord serum levels of cortisol in IUGR infants (455 +/- 189 nmol/L) were slightly higher than those of the control infants (408 +/- 247 nmol/L). The DS/cortisol molar ratio in IUGR infants (10.5 +/- 6.8) was 41% lower (p = 0.0013) than that of the control infants (17.7 +/- 13). Also, the estimated DS plasma pool in IUGR infants (521 +/- 349 nmol) was strikingly lower (p = 0.0018) than that of the control infants (800 +/- 480 nmol); the estimated plasma pools of cortisol were equivalent (growth-retarded: 53 +/- 27 nmol; control: 55 +/- 34 nmol). Although we anticipated that total cholesterol and apo B levels in IUGR infants would be increased due to reduced adrenal utilization of LDL for DS production, such was not the case. We conclude that a selective deficiency of DS production occurs in the IUGR fetus.

[Calcipenic osteopathy in transfusion hemosiderosis and idiopathic hemochromatosis]

Bone metabolism studies were performed on 5 patients with transfusion haemosiderosis (2 male, 3 female; mean age: 30.8 years) and 5 patients with idiopathic haemochromatosis (2 male, 3 female; mean age: 48.8 years). In the majority of the patients, the modern osteodensitometric method showed a significant decrease of the mineral content of the trabecular and cortical bones. Low calcitonin and dehydroepiandrosterone-sulphate concentrations were measured in the majority of the patients with calcipenic osteopathy. Besides marked bone loss, hypogonadotropic hypogonadism was found in 3 male patients, while normal LH, FSH concentration values were measured in 3 female patients. The prolactin concentration was normal in all 6 patients. The authors suppose that besides the already known pathogenetic factors, insufficient calcitonin effect and especially the partial lack of dehydroepiandrosterone-sulphate can play a role in the development of bone loss connected with iron overload. Further study with a greater number of patients in required to support the above findings.

Adrenocortical insufficiency

Adrenocortical insufficiency causes difficulty in diagnosis and morbidity out of proportion to its rarity, because of the non-specific, multi-system nature of the clinical features. Most of these are due to cortisol deficiency. Prominent features are well-known ones such as weight loss and asthenia, and hypoglycaemia. Less prominent in recent accounts are those due to failure of cellular sodium export and to vasopressin excess, which are frequent and clinically significant. For this reason, the clinical features of isolated ACTH deficiency, isolated glucocorticoid deficiency and Addison's disease overlap greatly. In addition, cortisol deficiency has secondary endocrine effects, e.g. glucocorticoid-reversible hypothyroidism, hyperprolactinaemia and hypercalcaemia. Further overlap between the various steroid insufficiency syndromes occurs because of the association of various organ-specific autoimmune endocrinopathies with Addison's disease. Over 80% of Addison's disease is of the autoimmune type, though almost any systemic destructive process can cause similar steroid insufficiency. Demonstration of adrenal insufficiency requires various combinations of tetracosactrin adrenal stimulation tests, and hypoglycaemia or equivalent tests, if the cause is ACTH deficiency but the correct test can only be chosen to suit a firm clinical diagnosis. The treatment of adrenocortical insufficiency is described.

[Treatment of pituitary nanism: is it necessary to treat adrenal androgen deficiency?]

In 17 hypopituitary prepubescent children (14 males and 3 females), aged 14.5 +/- 2.1 years, treated for more than 2 years with human growth hormone (hGH), with bone ages of 10.4 +/- 1.4 years and plasma dehydroepiandrosterone (DHA and/or DHA-S) levels lower than the normal values for bone age, low dose androgen therapy (norethandrolone 0.25 mg/kg/day 2 of 3 months) was added to the previous treatment. The speed of growth doubled during the first six months of associated treatment. For 15 patients so treated for one year,the height gain was 7.5 +/- 1.56 cm versus 4.47 +/- 1.2 cm the preceding year. During this first year of treatment, bone age, on an average, progressed less quickly than height. The combination of hGH and low grade androgenic steroid therapy allows for the acceleration of the growth in height without increasing the doses of hGH. A prolonged controlled trial of this therapy in hypopituitary prepubescent children with bone age of at least 8 years and known deficiency of androgenic secretion by the adrenal glands is suggested.

[Psoriasis and haemodialysis: changes in plasma hormone concentration as a possible therapeutic mechanism (author's transl)]

Free dehydroepiandrosterone (DHEA), DHEA sulphate, testosterone, LH and FSH were measured in plasma from 67 patients with renal disease before and after haemodialysis or haemofiltration. Plasma concentration of the steroid hormones was lower in patients with renal failure than in normal controls, while that of the gonadotrophic hormones was elevated. After haemodialysis or haemofiltration DHEA sulphate level in plasma decreased, free DHEA increased significantly reaching almost the initial value of the control group. There was no change in concentration of the other steroid and gonadotrophic hormones. The likely mechanism is that haemodialysis removes DHEA deficiency in patients with psoriasis which is assumed to be an aetiopathogenetic factor in the disease.

[Dehydroepiandrosterone deficiency in psoriasis. Hypothesis on the etiopathogenesis of this disease]

In patients with psoriasis in extra- and intracellular deficiency of dehydroepiandrosterone can be demonstrated which leads to an activation of the pentose-phosphate cycle. This dehydroepiandrosterone deficiency is caused by an increased intracellular activity of 17 beta-hydroxysteroid-dehydrogenase. This results in an increased formation of the reduction product androstendiol, which is unable to inhibit the glucose-6-phosphate dehydrogenase, the keye enzyme of the pentose-phosphate cycle. In addition, a decreased penetration of the steroid through the membrane of erythrocytes is demonstrable, by which the intracellular deficiency of dehydroepiandrosterone is still augmented. The effects of this dehydroepiandrosterone deficiency are changes in the humoral regulation of events in growth and proliferation in patients with psoriasis.

Inhibition of spontaneous breast cancer formation in female C3H(Avy/a) mice by long-term treatment with dehydroepiandrosterone

Long-term p.o. treatment with dehydroepiandrosterone, an adrenal steroid found in subnormal plasma concentrations in women predisposed to develop breast cancer, inhibits the formation of spontaneous mammary cancer in female C3H(Avy/a) mice.

[Psoriasis: A general disease? Can psoriasis be explained biochemically?]

The biochemical problems of psoriasis are discussed, especially two modern hypothesis about the pathogenesis of this skin disease. 1. DHEA-deficiency leading to an increase of G-6-PDH inaugurated by Holzmann et al. 2. cAMP deficiency in psoriatic lesions as a cause of psoriasis hypothized by Voorhees and Duell. A synopsis of the physiology of the steroid hormone DHEA (synthesis, regulation, conjugation and excretion) is given. There are doubts that this hypothesis is correct. Recent findings have indicated, that there is no decrease of cAMP in the psoriatic lesion--in contrast there is an increase of this cyclic nucleotid. It means that this theory is also doubtfull. Treatment of an hypothetical decrease of cAMP by AMP is not possible, because this AMP will not penetrate in the cell and cannot be metabolized to cAMP.