Primary Adrenal Insufficiency in Women With Low Libido, Depressive Symptoms, and Low Energy
In female patients with primary adrenal insufficiency, low libido, depressive symptoms, and low energy can persist even after glucocorticoid and mineralocorticoid replacement has been fully optimized. Current evidence addresses this specific sub-population with a distinct therapeutic approach.
Clinical Scenario
Women with PAI who experience reduced libido, depressive symptoms, and low energy levels that persist despite otherwise optimized glucocorticoid and mineralocorticoid replacement represent a defined sub-population for whom standard adrenal hormone replacement alone may not be sufficient.
Treatment Approach
Evidence supports a trial of DHEA replacement in this setting, followed by formal evaluation of whether a sustained beneficial effect has been achieved — after which continuation or discontinuation is decided. The complete regimen, including how the trial is structured and assessed, is in the full protocol.
Treatment Goal
The primary biochemical target is morning serum DHEA sulfate (DHEAS) in the midnormal range, measured before the daily replacement dose. Continuation depends on documented clinical benefit; full monitoring criteria are in the structured protocol.
References
DOI: 10.1210/jc.2015-1710
We suggest a trial of dehydroepiandrosterone (DHEA) replacement in women with PAI and low libido, depressive symptoms, and/or low energy levels despite otherwise optimized glucocorticoid and mineralocorticoid replacement.
We suggest monitoring DHEA replacement by measuring morning serum DHEAS levels (aiming at the midnormal range) before the intake of the daily DHEA replacement dose.