DHEAS Elevation as the Early Biochemical Abnormality in ACTH-Secreting Pituitary Microadenomas in Children: Two Case Reports

May 5, 2026Endocrine, metabolic & immune disorders drug targets

Early Increase of DHEAS in Children with Small ACTH-Producing Pituitary Tumors: Two Case Reports

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Abstract

Both cases exhibited significant elevation of Dehydroepiandrosterone Sulfate (DHEAS) despite near-normal ACTH and cortisol levels.

ACTH-secreting pituitary microadenomas may present with atypical clinical features in children.
Case 1 showed growth retardation for two years before developing Cushing's Syndrome.
Case 2 experienced excessive weight gain and amenorrhea prior to the diagnosis.
Normal initial pituitary MRI findings did not exclude the presence of a microadenoma.
Pathological confirmation of both cases followed Transsphenoidal Surgery.

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INTRODUCTION: ACTH-secreting pituitary microadenomas are associated with insidious onset in children and atypical early clinical manifestations, making them highly susceptible to misdiagnosis and underdiagnosis. They are characterized by elevated ACTH and cortisol levels with a disrupted circadian rhythm. We reported two pediatric cases that showed significant elevation of Dehydroepiandrosterone Sulfate (DHEAS) and Androstenedione (Ad) in the early stage, while ACTH and cortisol were in the normal range or mildly abnormal.

CASE PRESENTATION: Case 1, a 13-year-old male, was admitted to the hospital with two years of growth retardation. The initial pituitary Magnetic Resonance Imaging (MRI) was normal. After one year, the patient developed Cushing's Syndrome (CS), and a repeat MRI suggested a pituitary microadenoma. Case 2, a 13.1-year-old female who had experienced excessive weight gain for two years and amenorrhea for 11 months. The child presented with CS initially, and the MRI revealed a pituitary microadenoma. Both of them were pathologically confirmed as ACTH-secreting pituitary microadenomas after Transsphenoidal Surgery (TSS).

CONCLUSION: This report demonstrates that in cases with a significant DHEAS elevation, even with near-normal ACTH/cortisol levels and negative pituitary MRI, high clinical suspicion for ACTH- secreting microadenomas should be maintained, warranting close follow-up and further evaluation.

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DHEAS Elevation as the Early Biochemical Abnormality in ACTH-Secreting Pituitary Microadenomas in Children: Two Case Reports

Abstract

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