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Year : 2011  |  Volume : 3  |  Issue : 1  |  Page : 43-44  

Hyposecretion of the adrenal androgen dehydroepiandrosterone sulfate (DHEA-S) in the majority of the alopecia areata patients: Is it a primitive and pathogenic perturbation of hypothalamic-pituitary-adrenal axis?

1 National Coordinator, Trichology Group, Associazione Italiana Dermatologi Ambulatoriali (AIDA) - Day Hospital S.Camillo, Monopoli (Bari), Italy
2 Department of Statistics "C. Cecchi", University of Bari, via C. Rosalba 53, 70124 Bari, Italy

Date of Web Publication16-Jun-2011

Correspondence Address:
Roberto d'Ovidio
via F. Campione,2 Bari
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-7753.82130

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d'Ovidio R, d'Ovidio FD. Hyposecretion of the adrenal androgen dehydroepiandrosterone sulfate (DHEA-S) in the majority of the alopecia areata patients: Is it a primitive and pathogenic perturbation of hypothalamic-pituitary-adrenal axis?. Int J Trichol 2011;3:43-4

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d'Ovidio R, d'Ovidio FD. Hyposecretion of the adrenal androgen dehydroepiandrosterone sulfate (DHEA-S) in the majority of the alopecia areata patients: Is it a primitive and pathogenic perturbation of hypothalamic-pituitary-adrenal axis?. Int J Trichol [serial online] 2011 [cited 2021 Jul 26];3:43-4. Available from:


Basic and clinical research suggest that disturbed neuro-endocrine function may be involved in the pathogenesis and course of autoimmune diseases. Hormones, such as those of hypothalamic-pituitary-adrenal Axis (HPA), are known to operate a modulation of immune responses. [1] In this report, we looked into the basal serum levels of four hormones: prolactin, ACTH, cortisol, dehydroepiandrosterone sulfate (the stable metabolite of the active steroid DHEA) by means of RIA method, to investigate if it could be a gross HPA axis perturbation in severe cases of alopecia areata disease (involvement >25% of scalp hair) as it appears in other autoimmune illness, such as in rheumatoid arthritis, systemic lupus erythematosus, Sjogren disease [2] and Hashimoto's thyroiditis [3] the last one so often associated to alopecia areata. [4] We studied a total of 142 patients - 55 males and 87 females- average age 34 years, not in systemic steroid therapy [Table 1]; they are members of the "Associazione Mediterranea Alopecia Areata" ( We confirmed the normal value of prolactin level [5] and did not find significant imbalance of basal level of ACTH and cortisol, but DHEA-S in the majority of the patients was found reduced in comparison to age and sex matched controls: 69.1% of males (M) and 74.7% of females (F) are below the media of the control values - 165.80±98.69 mcg/dl (M) and 101.36±97.22 mcg /dl (F) versus 228.07±151.81 mcg/dl (M- control) and 134.49±104.64 mcg/dl (F -control) - Student's t-test P<0.00002 and Mood's median-test P<0.0000001 respectively-. 63.6% of M and 64.4% of F are in the range of deficiency values - given by mean minus s.d./3: <177, 47 mcg/dl for M and <99,60 mcg /dl for F [Figure 1]- irrespective of their age, clinical forms and duration of the disease. At the moment, we cannot determine with certainty whether this deficit is pre-existing or subsequent to the onset of pathology, but the low DHEA-S secretion also found in the majority of the patients in the remission phase and those with recent onset of the pathology -whereas cortisol and ACTH were in the normal range- could be indicative of a primitive deficit of DHEA-S production. These results confirm the old data from Vinocurow [6] and Montagnani: [7] they found in 85% of patients a hypoadrenalism through dosing of urinary steroids, independently from the clinical form of Alopecia. Many studies have shown that DHEA/DHEA-S has significant immunomodulating activity and could be useful in restoring immune regulation in patients with chronic autoimmune diseases, [8] probably through its capacity to modulate the mechanisms of natural immunity, such as NK cells, that can control the activation of T autoreactive linphocytes, event that appears in some autoimmune diseases, including alopecia areata. [9] On the other hand, DHEA is a neurohormone with antidepressive - ansiolytic activity and low DHEA-S secretion is considered as indicative of chronic stress response, [10] whose involvement in the pathogenesis of AA is to be considered. [11] Our preliminary therapeutic data suggest the clinical usefulness in some patients of the normalitation of the defective level of DHEA-S, but it is mandatory to investigate in a consistent number of cases affected from severe chronic/relapsing AA if the administration of DHEA could be a new additive relatively safe and inexpensive resource for the stabilization of this desperating disease, as it is suggested for other autoimmune pathologies. [8]
Figure 1: DHEA-S mean values in sample (normal mean and median: males=228.07±151.81 mcg/dl; females=134.49±104.64 mcg/dl): Sample mean: males=165.80±98.69 mcg/dl (n=55, Student's t-test P<0.00002), females=101.36±97.22 mcg/dl (n=87, not normally distributed, therefore, given the median=73.8, Mood's median-test P<0.0000001).

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Table 1: Case study

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   References Top

1.Eskandari F, Webster JI, Sternberg EM. Neural immune pathways and their connection to inflammatory diseases. Arthritis Res Ther 2003;5:251-65.   Back to cited text no. 1
2.Forsblad-d'Elia H, Carlsten H, Labrie F, Konttinen YT, Ohlsson C. Low serum levels of sex steroids are associated with disease characteristics in primary Sjogren's syndrome; supplementation with dehydroepiandrosterone restores theconcentrations. J Clin Endocrinol Metab 2009;94:2044-51.  Back to cited text no. 2
3.Solerte SB, Precerutti S, Gazzaruso C, Locatelli E, Zamboni M, Schifino N, et al. Defect of a subpopulation of natural killer immune cells in Graves' disease and Hashimoto's thyroiditis: normalizing effect of dehydroepiandrosterone sulfate. Eur JEndocrinol 2005;152:703-12.  Back to cited text no. 3
4.Kasumagiæ-Haliloviæ E. Thyroid autoimmunity in patients with alopecia areata. Acta Dermatovenerol Croat 2008;16:123-5.  Back to cited text no. 4
5.Gönül M, Gül U, Cakmak S, Kilinç C, Kilinç S. Prolactine levels in the patients with alopecia areata. J Eur Acad Dermatol Venereol 2009;23:1343-4.  Back to cited text no. 5
6.Vinokurov IN. Pathogenesis of severe forms of alopecia areata. Sov Med 1972;35:127-31.  Back to cited text no. 6
7.Montagnani A, Orlandi F, Patrone P, Serra D, De Camillis M, Ferrari MG. Adrenal steroid-genetic activity in subjects with alopecia totalis or subtotalis diffuse alopecia and alopecia areata. Ital Gen Rev Dermatol 1978;15:13-5.  Back to cited text no. 7
8.Hazeldine J, Arlt W, Lord JM. Dehydroepiandrosterone as a regulator of immune cell function. J Steroid Biochem Mol Biol 2010;120:127-36.  Back to cited text no. 8
9.Kaufman G, d'Ovidio R, Kaldawy A, Assy B, Ullmann Y, Etzioni A, et al. An unexpected twist in alopecia areata pathogenesis: are NK cells protectiveand CD49b+ T cells pathogenic? Exp Dermatol 2010;19:e347-9  Back to cited text no. 9
10.Jeckel CM, Lopes RP, Berleze MC, Luz C, Feix L, Argimon II, et al. Neuroendocrine and immunological correlates of chronic stress in 'strictlyhealthy' populations. Neuroimmunomodulation 2010;17:9-18.  Back to cited text no. 10
11.Picardi A, Pasquini P, Cattaruzza MS, Gaetano P, Baliva G, Melchi CF, et al. Psychosomatic factors in first-onset alopecia areata. Psychosomatics 2003;44:374-81.  Back to cited text no. 11


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