Iatrogenic Cushing's syndrome from an adulterated glucocorticoid-containing supplement

A man in his 40s presented with rapid weight gain, fatigue and clinical signs of Cushing's syndrome, including abdominal striae and centripetal obesity. Laboratory testing revealed suppressed serum cortisol and adrenocorticotropic hormone levels. He denied prescribed glucocorticoid use but disclosed consumption of the supplement Artri King Reforzado Con Ortiga Y Omega 3 for joint pain. The U.S. Food and Drug Administration (FDA) had recalled this product for undeclared dexamethasone. The patient's symptoms started a few weeks after he discontinued the supplement and gradually improved with initiation of hydrocortisone for treatment of secondary adrenal insufficiency due to exogenous glucocorticoid use. This case illustrates the potential harm of adulterated supplements and the importance of obtaining a thorough medication and supplement history in cases of suspected iatrogenic Cushing's syndrome.