Over the Counter (OTC) Dehydroepiandrosterone-Sulfate Supplementation (DHEA-S): A Potential Cause of Low Cortisol Levels

Document Type

Abstract

Publication Date

9-1-2025

Abstract

Description: Case Report: A 33-year-old woman with subfertility presented with 1 month of fatigue and low cortisol levels. She denied low blood pressure, weight changes, or skin hyperpigmentation. Her reproductive history included failed in vitro fertilization treatments and a miscarriage. Labs showed morning cortisol at 0.4 μg/dL and adrenocorticotropic hormone (ACTH) at 20 pg/mL. She disclosed using over the counter dehydroepiandrosterone (DHEA) (100 mg/d, recently increased to 300 mg/d) to enhance fertility, with DHEA-S levels at 400 μg/dL. After stopping DHEA, her cortisol normalized to 14.2 μg/dL, and ACTH normalized to 27 pg/mL. Discussion: Excessive DHEA-S supplementation suppresses cortisol production through feedback inhibition of the hypothalamic-pituitary-adrenal axis. In this case, high-dose DHEA use elevated serum DHEA-S and suppressed cortisol, resulting in transient adrenal insufficiency. Normalization of cortisol and ACTH after stopping DHEA highlights the reversible nature of this suppression. Conclusion: Prolonged or high-dose DHEA-S can suppress cortisol production through a negative feedback mechanism. Healthcare professionals should carefully review medication histories, including over-the-counter supplements. This case underscores the need for more stringent monitoring of unsupervised supplement use.

Publication Title

Endocrine Practice

Volume

31

Issue

9 Supplement

First Page

S152

Last Page

S153

Comments

AACE Annual Meeting 2025 held 2025-05-15 to 2025-05-17 in Orlando, FL, USA.

Link to Full Text

Open Access

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