Exogenous Cushing Syndrome Caused by a "Herbal" Supplement

Area of Science:

• Endocrinology
• Pharmacology
• Toxicology

Background:

• Exogenous Cushing syndrome is typically linked to known glucocorticoid exposure.
• Occult glucocorticoid use, particularly from unregulated sources, presents a diagnostic challenge.

Observation:

• Two cases of women developed Cushing syndrome while taking Artri King (AK), an over-the-counter herbal supplement for joint pain.
• Both patients presented with symptoms consistent with Cushing syndrome, including weight gain, hypertension, and metabolic changes.
• Laboratory tests confirmed elevated synthetic glucocorticoid levels and suppressed cortisol and ACTH, which normalized after discontinuing AK.

Findings:

• Artri King, an herbal supplement, was found to contain undeclared glucocorticoids, specifically dexamethasone.
• Discontinuation of Artri King led to the resolution of clinical symptoms and normalization of hormone levels in both patients.
• These cases demonstrate a direct causal link between AK consumption and the development of exogenous Cushing syndrome.

Implications:

• Healthcare providers must consider the possibility of occult glucocorticoid exposure from unregulated herbal supplements when evaluating patients with Cushing syndrome.
• Increased awareness and screening for hidden glucocorticoids in supplements are crucial for accurate diagnosis and management.
• Regulatory oversight of herbal supplements is necessary to prevent adverse health outcomes associated with undeclared pharmaceutical ingredients.