Hormones
Pregnenolonsulfaat
The storage form of pregnenolone, the precursor of the steroid hormones; mainly meaningful when testing for a rare adrenal disorder.
Everything about this testWhat it measures
Pregnenolone is made from cholesterol, mainly in the adrenal glands and in smaller amounts in the ovaries or testes. It is the common precursor of progesterone, cortisol, DHEA and the sex hormones. A large part is converted into pregnenolone sulfate, a form with a sulfate group that stays in the blood longer and is present in much higher concentrations than pregnenolone itself, similar to DHEAS compared with DHEA. Production in the adrenal gland is controlled by ACTH from the pituitary gland. Pregnenolone sulfate is also made in the brain, but the value in the blood says nothing about that.
- A clue to a disorder in the first steps of hormone production in the adrenal gland, in addition to cortisol, DHEAS and 17-hydroxypregnenolone
- Use of pregnenolone or DHEA supplements
High
A raised value is often due to the use of pregnenolone or DHEA supplements. The value is also higher in younger adults than in older people. In a rare congenital disorder of an adrenal enzyme (a form of congenital adrenal hyperplasia, CAH), pregnenolone and its sulfate form can build up because the next step in production does not work properly; this goes together with abnormalities in other adrenal hormones.
Low
A low value is often due to older age, because production in the adrenal gland decreases over the years, or to the use of corticosteroids (tablets, inhaler, nasal spray, skin cream or injection), which suppress the body's own production. With reduced function of the adrenal glands or the pituitary gland, the value is also low, but then it is mainly cortisol that is abnormal and there are symptoms such as severe tiredness, weight loss and low blood pressure. A low value without symptoms says little and does not explain tiredness, low mood or memory problems. The idea that stress 'steals' pregnenolone at the expense of the sex hormones has not been proven.
If your result is abnormal
With an abnormal value, the GP looks at age, symptoms, medicines and supplements. With symptoms that fit an adrenal disorder, a morning cortisol measurement follows, with ACTH and other adrenal hormones if needed, and if an abnormality is confirmed, referral to an internist-endocrinologist. An abnormal value without symptoms usually does not lead to further tests.
Reliability
The meaning of a single pregnenolone sulfate value has been little studied, and there are no agreed cut-off values outside research into rare adrenal disorders. The result is mainly meaningful when it is assessed together with cortisol, ACTH, DHEAS and other adrenal hormones. As a measure of 'hormone balance', energy, mood, memory or aging, pregnenolone sulfate is not supported by evidence. According to Thuisarts.nl, with tiredness and no other symptoms, blood tests almost never find a cause.
Limitations
- The value depends strongly on age; only compare with reference values for the same age and sex.
- Corticosteroids lower the value; pregnenolone and DHEA supplements raise it.
- Few laboratories measure pregnenolone sulfate and test methods differ, so results from different laboratories are hard to compare.
- Severe illness and pregnancy temporarily change the value.
How common is this
The severe form of congenital adrenal hyperplasia is diagnosed in 12 to 15 children a year in the Netherlands, nowadays usually through the heel prick test; the forms in which pregnenolone builds up are a small and very rare part of these. Reduced function of the adrenal glands is rare. Tiredness is common and almost never has a cause that is found with blood tests.
Who is this useful for
The result is most meaningful with a specific question about a congenital disorder in the production of adrenal hormones, together with other adrenal hormones. Not suitable as a measure of 'hormone balance', stress, tiredness, mood, memory or aging, or for choosing a supplement. In people without symptoms, a single value says little.
Downsides and risks
- An abnormal value without symptoms can cause unnecessary worry about the adrenal glands and unnecessary further tests.
- A 'low' value is sometimes used as a reason to take pregnenolone or DHEA; this is not supported by evidence, and DHEA is on the doping list.
Sources
Always discuss an abnormal result with your GP. If a result is strongly abnormal, we try to reach you as soon as possible. Read your result yourself as well and contact your GP if in doubt. A test does not make a diagnosis. Read more about risks and results