MON-079 A Case of Iatrogenic Cushing’s Syndrome Following Use of a Foreign Herbal Supplement

Abstract Disclosure: D.L. Torres-Pinzon: None. L. Song: None. N. Mogar: None. Prolonged exposure to exogenous glucocorticoids contributes to secondary adrenal insufficiency, while chronic use of supraphysiologic doses can lead to iatrogenic Cushing’s syndrome (ICS), typically associated with oral or parenteral steroids for autoimmune or inflammatory diseases. Rarely, ICS has been reported from hidden steroid exposure in supplements. We discuss the case of a patient who developed Cushing’s syndrome after using a foreign herbal supplement labeled for pain management. A 54-year-old female with fibromyalgia, hypertension, hyperlipidemia, obesity, and type 2 diabetes presented with fatigue, weight gain, and laboratory findings consistent with secondary adrenal insufficiency with AM cortisol 0.7 mcg/dL (ref. 4 - 22 mcg/dL), adrenocorticotropic hormone (ACTH) level <5 pg/mL (ref. 6 - 50 pg/mL), and cosyntropin stimulation test (CST) with 1-hour peak cortisol of 13.2 mcg/dL (ref. >14.6 mcg/dL) while off of steroids. MRI revealed a small pituitary gland but no pituitary mass. She was started on hydrocortisone, which was later discontinued due to intolerance, and she was then transitioned to prednisone 5 mg daily. Within one week, she developed facial swelling, increased appetite, leg swelling, neuropathy, palpitations, hypertension, and hyperglycemia, prompting discontinuation of prednisone. The patient then presented to our clinic for further work up, and on initial evaluation, she had a BMI of 39.87 kg/m², moon facies, supraclavicular and dorsal fat deposition. She had discontinued steroids two months prior to her presentation but revealed that she had been taking fifteen different herbal supplements. Repeat laboratory evaluation revealed a suppressed AM cortisol (0.3 mcg/dL) and ACTH (3 pg/mL), elevated serum dexamethasone (886.1 ng/dL, ref. <50 ng/dL), TSH 0.19 mIU/L (ref. 0.3 - 4.7 mIU/L), and free T4 1.1 ng/dL (ref. 0.8 - 1.7 ng/dL). Discontinuation of all supplements led to improvement in labs after four weeks AM cortisol 6.6 mcg/dL, ACTH 25 pg/mL, dexamethasone <20 ng/dL (ref. <20 ng/dL), TSH 1.19 mIU/L and free T4 0.9 ng/dL. Laboratory analysis of all fifteen supplements confirmed the presence of high levels of dexamethasone in one supplement from the Ivory Coast labeled “Pain Medication”. A repeat CST is in process. Exposure to high levels of dexamethasone in this herbal supplement used to treat chronic pain led to secondary adrenal insufficiency (AI) with subsequent development of ICS and subclinical hyperthyroidism from steroid-induced TSH suppression. Stopping the culprit supplement resulted in improvement in the HPA axis and normalization of thyroid function. Iatrogenic cushing syndrome from unintentional steroid exposure in supplements is rare but increasingly prevalent with the rise in herbal/dietary supplement use. Thorough history-taking, including potential exposures to supplements, is critical to avoid missed diagnoses of ICS. Presentation: Monday, July 14, 2025