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Case 1

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Question 1 Feedback -- DHEA

Interesting but not indicated initially in this patient's presentation.

You may investigate this further:

DHEA Sulfate levels and testosterone levels may be elevated in women with adrenal tumors and is indicated as a screening tool along with testosterone and cortisol evaluations in women with notable hirsutism , acne, significant trunkal obesity, and virilization (male pattern baldness, clitoromegaly, and voice changes). See the following PubMed reference:

Derksen J, Nagesser SK, Meinders AE, Haak HR, van de Velde CJ. Identification of virilizing adrenal tumors in hirsute women. N Engl J Med 1994 Oct 13;331(15):968-973.

This laboratory value may also be useful in anovulatory women who fail to respond to clomiphene citrate. It appears that treatment with dexamethasone may improve their responsiveness to clomiphene and thereby avoid the need for treatment with gonadotropins. See the references below.

Reference 1:

Lobo RA, Paul W, March CM, Granger L, Kletzky OA. Clomiphene and dexamethasone in women unresponsive to clomiphene alone. Obstet Gynecol 1982 Oct;60(4):497-501.

Reference 2:

Daly DC, Walters CA, Soto-Albors CE, Tohan N, Riddick DH. A randomized study of dexamethasone in ovulation induction with clomiphene citrate. Fertil Steril 1984 Jun;41(6):844-848.

Reference 3:

Trott EA, Plouffe L Jr, Hansen K, Hines R, Brann DW, Mahesh VB. Ovulation induction in clomiphene-resistant anovulatory women with normal dehydroepiandrosterone sulfate levels: beneficial effects of the addition of dexamethasone during the follicular phase. Fertil Steril 1996 Sep;66(3):484-486.

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