Unregulated Joint Supplement Triggers Iatrogenic Cushing’s Syndrome
A patient in his 40s developed iatrogenic Cushing’s syndrome after taking an over-the-counter joint pain remedy called Artri King Reforzado Con Ortiga Y Omega 3 for nine months, according to a case report published in BMJ Case Reports and covered by MedPage Today. The condition, characterized by rapid weight gain and abdominal stretch marks, stems from prolonged exposure to glucocorticoids. The patient initially denied taking any such medications, but subsequent questioning revealed he used the supplement as a natural remedy recommended by a colleague. Investigators later noted that the product contained undeclared dexamethasone, prompting a prior safety recall from the U.S. Food and Drug Administration.
Clinical Presentation and Endocrine Workup
The patient presented with a six-month history of progressive fatigue, intermittent nausea, bilateral foot discomfort, and an unintentional weight gain exceeding 99 pounds. He also managed type 2 diabetes, hypertension, arthritis, and a history of obesity that he previously addressed through lifestyle changes. Physical examination revealed classic Cushingoid features, including marked truncal obesity, facial rounding, wide pinkish-violaceous stretch marks across the lower abdomen, and mild proximal muscle weakness in both upper and lower limbs.
A pituitary magnetic resonance imaging scan returned negative for any lesion, while laboratory testing confirmed low morning cortisol and adrenocorticotropic hormone (ACTH) levels. Endocrinologists performed a detailed evaluation to assess both exogenous glucocorticoid exposure and endogenous cortisol excess. The discovery of the Artri King usage explained the hormonal suppression. According to Maria Fleseriu, MD, director of the Pituitary Center at Oregon Health & Science University in Portland, who was not involved in the case, clinicians frequently encounter similar presentations. Fleseriu noted to MedPage Today that some internet-purchased arthritis supplements contain undeclared glucocorticoids that produce classic Cushingoid features while suppressing ACTH and endogenous cortisol production.
Treatment and Recovery Protocol
Physicians initiated physiologic hydrocortisone replacement therapy to address the patient’s secondary adrenal insufficiency. Medical staff gradually tapered the treatment over a four-month period while monitoring the recovery of his hypothalamic-pituitary-adrenal axis function until it fully recovered. Although his symptoms gradually improved, persistent arthritis prevented him from losing weight independently. The patient eventually underwent bariatric surgery, which successfully normalized his blood glucose levels through subsequent weight loss. Healthcare providers also supplied him with education regarding the signs of adrenal insufficiency and counseling concerning the dangers of unregulated supplements.
Regulatory Gaps and Clinical Awareness
Authors Hima Darapu, MD, of Wake Forest Baptist Medical Center in Winston-Salem, and Sagarika Gokul, MD, of Prisma Health in Greenville, South Carolina, emphasized the broader implications of the case. They stated that the incident highlights the serious and often overlooked dangers posed by unregulated over-the-counter products containing undeclared pharmacologically active substances. Fleseriu added that many case reports document Cushing’s syndrome resulting from contaminated or higher-than-declared doses of herbal supplements, underscoring the necessity of a meticulous supplement history during patient evaluations. Despite existing FDA safety alerts and product recalls, these adulterated natural remedies remain accessible through online and retail markets, pointing to persistent regulatory gaps that require stronger oversight and improved clinician awareness.