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[Is there an indication for dehydroepiandrosterone (DHEA) treatment in elderly women with Addison disease? Beneficial and adverse effects of DHEA].

DHEA is a cetosteroid secreted by the adrenal gland. Serum levels of DHEA decline by an average of 10% per decade whereas cortisol levels remain stable. The relative lack of DHEA secretion in elderly people has been called adrenopause. The daily administration of 50 mg of DHEA to women over 60 years old results in a two-fold increase in serum level of testosterone and androstenedione and in a 10% increase of estradiol in men. A 10 to 20% increase of IGF-1 is observed in both sexes. In women over 70 years old treated by 50 mg/day of DHEA for 6 months an improvement of bone turnover and of skin status was observed as well as an increase of overall well-being and of libido. These beneficial psychological effects have also been observed in younger men and women with adrenal insufficiency. In men 50 to 65 years old, 100 mg/day of DHEA for 6 months could slightly increase the lean body mass and the muscle strength. Moreover DHEA could increase immune function and NK cell activity. As there are no actual data about cardio-vascular and oncological risks of a prolonged treatment with DHEA, the administration of this steroid must still be considered experimental. Previous or present cancer of the breast or of the prostate is an absolute contraindication to DHEA treatment.