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Urinary free cortisol (UFC) is a predictor of weight gain, but 24\u2010h urine samples are challenging to collect. We hypothesized that serum dehydroepiandrosterone sulfate (DHEAS), which like cortisol is regulated by adrenocorticotropic hormone (ACTH), would predict weight gain and increases in fat mass in women with AN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively studied 34 women with AN and atypical AN, mean age 27.4\u2009\u00b1\u20097.7\u2009years (mean\u2009\u00b1\u2009SD), who received placebo in a 6\u2010month randomized trial. Baseline DHEAS and 24\u2010h UFC were measured by liquid chromatography with tandem mass spectrometry. Body composition was assessed at baseline and 6\u00a0months by DXA and cross\u2010sectional abdominal CT at L4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean baseline DHEAS level was 173\u2009\u00b1\u200970\u2009\u03bcg\/dl (0.7\u2009\u00b1\u20090.3 times the mean normal range for age) and mean baseline UFC (<jats:italic>n<\/jats:italic>\u00a0=\u00a015) was 20\u2009\u00b1\u200918\u2009\u03bcg\/24\u2009h (normal: 0\u201350\u2009\u03bcg\/24\u2009h). Higher DHEAS levels predicted weight gain over 6\u00a0months (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.61, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). DHEAS levels also predicted increases in fat mass (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.40, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.03), appendicular lean mass (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.38, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.04), and abdominal adipose tissue (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.60, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). All associations remained significant after controlling for age, baseline BMI, OCP use, duration of AN, and SSRI\/SNRI use. DHEAS levels correlated with UFC (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.61, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In women with AN, higher serum DHEAS predicts weight gain and increases in fat and muscle mass. Additional studies are needed to confirm these findings and further elucidate the association between DHEAS and weight gain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Public Significance<\/jats:title><jats:p>Anorexia nervosa is a severe psychiatric condition, and predictors of weight recovery are needed to improve prognostication and guide therapeutic decision making. While urinary cortisol is a predictor of weight gain, 24\u2010h urine collections are challenging to obtain. Like cortisol, dehydroepiandrosterone sulfate (DHEAS) is a hormone produced by the adrenal glands. As a readily available blood test, DHEAS holds promise as more practical biomarker of weight gain in anorexia nervosa.<\/jats:p><\/jats:sec>","DOI":"10.1002\/eat.23767","type":"journal-article","created":{"date-parts":[[2022,7,2]],"date-time":"2022-07-02T14:50:06Z","timestamp":1656773406000},"page":"1100-1107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Dehydroepiandrosterone sulfate levels predict weight gain in women with anorexia nervosa"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6750-644X","authenticated-orcid":false,"given":"Allison","family":"Kimball","sequence":"first","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9062-8667","authenticated-orcid":false,"given":"Caitlin","family":"Colling","sequence":"additional","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1002-4754","authenticated-orcid":false,"given":"Melanie S.","family":"Haines","sequence":"additional","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erinne","family":"Meenaghan","sequence":"additional","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1586-0930","authenticated-orcid":false,"given":"Kamryn T.","family":"Eddy","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Eating Disorders Clinical and Research Program Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9405-2981","authenticated-orcid":false,"given":"Madhusmita","family":"Misra","sequence":"additional","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen K.","family":"Miller","sequence":"additional","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,7,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0672"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-68-3-548"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/36.1.172"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197701272960403"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2830"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1010748"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-4731(80)90209-5"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.15m10393"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0306-4530(00)00035-4"},{"key":"e_1_2_10_12_1","volume-title":"Cognitive behavior therapy and eating disorders","author":"Fairburn C. 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