# Elevated Dehydroepiandrosterone Sulfate Levels in 2 Patients With Prolactinomas: An Underrecognized Association

## TL;DR

Two patients with prolactinomas had elevated DHEA-S levels, suggesting a rare but treatable connection between these conditions.

## Contribution

Reports two cases linking hyperprolactinemia and elevated DHEA-S, highlighting a potential underrecognized clinical association.

## Key findings

- Two male patients with prolactinomas had elevated DHEA-S and prolactin levels.
- Cabergoline treatment normalized both DHEA-S and prolactin levels in both patients.
- The association suggests that prolactinomas may be an underrecognized cause of elevated DHEA-S.

## Abstract

While adrenal androgen production is primarily regulated by ACTH, some data suggest a less common association between hyperprolactinemia and elevated dehydroepiandrosterone sulfate (DHEA-S). We describe 2 patients with this underrecognized connection. Patient 1, a 60-year-old male, was incidentally found to have bilateral adrenal masses on computed tomography during evaluation of gastrointestinal complaints. Further workup revealed elevated levels of DHEA-S and prolactin, with pituitary macroadenoma identified as the cause, given normalization of both prolactin and DHEA-S on cabergoline therapy. Patient 2, a 38-year-old male, presented with visual field defects, and subsequent pituitary magnetic resonance imaging confirmed a macroadenoma. He also had markedly elevated levels of DHEA-S and prolactin. Both patients were treated with cabergoline, leading to rapid normalization of both prolactin and DHEA-S levels. These cases demonstrate an association between hyperprolactinemia and elevated DHEA-S, supported by the normalization of levels with medical treatment of prolactinoma. Although hyperprolactinemia in the context of a prolactinoma is an uncommon cause of elevated DHEA-S, it should be considered once other etiologies have been excluded.