Impact of Surreptitious Glucocorticoids in Over-the-Counter Arthritis Supplements

Adrenal dysfunction due to over-the-counter (OTC) health supplements containing unlabeled glucocorticoids has been previously reported. Here, we present a case series of 12 patients at an urban safety net medical center evaluated by endocrinology for iatrogenic adrenal dysfunction, Cushing syndrome (CS) and/or adrenal insufficiency (AI), associated with use of OTC arthritis supplements surreptitiously containing glucocorticoids. There were 12 patients using OTC arthritis supplements (Artri King [n = 8], Ardosons [n = 3], Ajo Rey [n = 1]) included. The mean age was 51.6 years and 33.3% were female. Findings of CS were identified in 10/12 (83.3%) patients, including moon facies (66%), central adiposity (66%), and abdominal striae (50%). Symptoms of AI were identified in 8/12 (66.7%) patients, including nausea/vomiting (42%), fatigue (42%), and abdominal pain (33%). Of 10/12 (83.3%) patients initially needing glucocorticoid replacement therapy, 4 continue to require treatment, 3 have successfully discontinued treatment, and 3 have been lost to follow-up. The literature reviewed identified 10 cases in 7 previously published reports, which did not include consistent follow-up data on adrenal function after discontinuation of the supplement. This case series demonstrates possible presentations of CS and/or AI from glucocorticoid exposure in patients taking these OTC arthritis supplements. Including more cases than all previously published reports combined, this series expands data for cortisol levels, cosyntropin test results, and glucocorticoid replacement needs for these patients and highlights the necessity for vigilant identification of supplement sources of exogenous steroids and the recognition of possible AI when such supplements are discontinued.