SUN-439 Hypothalamic-Pituitary-Adrenal Axis Disruption from Unregulated Glucocorticoid Use: A Case Series

Abstract Disclosure: S.P. potharaj: None. E. Oshinuga: None. Z. Roe-Zurz: None. A. Rajpal: None. R. Sharma: None. N. Doshi: None. Cushing syndrome is characterized by excessive cortisol production, which can be due to either endogenous overproduction or exogenous glucocorticoid use. Iatrogenic Cushing's syndrome results from chronic exposure to exogenous glucocorticoids, and symptoms can manifest when patients are unknowingly exposed to such medications. While most over-the-counter glucocorticoids in the U.S. are topical or inhaled and at lower doses, immigrant populations using prescribed or OTC medications not commonly available in the U.S. may face significant risks. We present a case series of four patients who developed iatrogenic hypothalamic-pituitary-adrenal (HPA) axis disruption due to OTC agents used for joint pain or as misguided vitamin injections.Patient 1: A 48-year-old man with no significant medical history presented with hypertension, weight gain, dorsocervical fat pad, and new, red striae on his abdomen. His symptoms occurred after using Arti King, a joint pain medication from another country.Patient 2: A 30-year-old woman with a history of asthma presented with an asthma exacerbation. During her evaluation, she exhibited cushingoid features, including central obesity and a moon face, in the context of receiving Betamethasone injections purchased over the counter from Mexico. These injections were marketed as "vitamin shots" for asthma and allergy relief.Patient 3: 51-year-old female with a history of type 2 diabetes mellitus, obesity, asthma, and knee osteoarthritis presenting with cushingoid features, in the setting of over-the-counter Arti-fles joint pain medication.Patient 4: A 50-year-old woman with a history of hypertension and osteoarthritis presented with fatigue, weight gain, facial hair growth, red striae on her abdomen, and amenorrhea, in the setting of taking over-the-counter medication Ardoson from another country for joint pain. Discussion: In cases like these, patients unknowingly use supplements containing hidden glucocorticoids, often marketed as "vitamins" or for other non-prescribed uses. Such exposures not only lead to iatrogenic Cushing syndrome but prolonged exposure also causes adrenal insufficiency, presenting a diagnostic and management challenge for healthcare providers. Medication reconciliation, particularly for immigrant populations, is critical to ensure that patients are not inadvertently exposed to harmful substances that may contribute to significant health complications. Conclusion: Iatrogenic Cushing syndrome due to unregulated OTC glucocorticoid use is an under-recognized issue, especially in immigrant patients who may use medications from other countries. Clinicians must be diligent in performing thorough medication histories and reconciling all substances, including non-prescription medications, to prevent unnecessary complications like adrenal axis disruption. Presentation: Sunday, July 13, 2025