SUN-482 A case of supplement induced Cushing’s syndrome resulting in secondary adrenal insufficiency

Abstract Disclosure: N.V. Kagita: None. G. Umarji: None. M. Stezzi: None. K. Desai: None. J. Watari: None. Background: Herbal therapies are readily accessible and frequently considered innocuous. Nevertheless, they may harbor dangerous substances that could result in unanticipated and possibly fatal outcomes. Case Presentation: A 74-year-old female with a history of controlled type 2 diabetes mellitus, Graves' disease, hyperlipidemia and asthma presented for endocrine evaluation for a low morning cortisol level of 1.8 µg/dL and an ACTH level of <1.5 pg/mL. Her electrolytes were within normal ranges, and her vital signs were stable. She weighed 75 kg with a BMI of 30.Physical examination revealed moon facies, facial plethora, a dorsocervical fat pad, and atrophic skin. A cosyntropin stimulation test was performed, showing a cortisol level of 5.1 µg/dL 60 minutes after cosyntropin, confirming adrenal insufficiency. She was initiated on glucocorticoid replacement therapy with prednisone 5 mg daily. The patient denied any recent exogenous glucocorticoid use. Remainder of pituitary labs were normal. MRI pituitary revealed no pituitary adenoma.On further investigation, the patient reported taking Montalin, an herbal supplement used for arthritis. She reported taking this supplement for the last year. On further review, it was discovered that Montalin contains corticosteroids and is associated with central adrenal insufficiency. She was instructed to stop Montalin. She was continued on glucocorticoid replacement therapy with close monitoring of her hypothalamic-pituitary-adrenal (HPA) axis to assess for recovery. Discussion: Exogenous steroid use is the most common etiology of secondary adrenal insufficiency, affecting approximately 2.5% of individuals using steroids for inflammatory or immune-mediated disorders. Patients with a history of glucocorticoid administration exhibiting signs and symptoms of exogenous Cushing’s syndrome are presumed to have glucocorticoid-induced adrenal insufficiency.Montalin, a herbal remedy used for analgesia, was previously found to contain dexamethasone and has been reported to be associated with central adrenal insufficiency. The restoration of the HPA axis is dependent upon the dosage and duration of glucocorticoid exposure. Montalin contains dexamethasone, a potent steroid with an extended duration of action, resulting in HPA axis recovery potentially taking up to one year. Conclusion: Physicians must maintain vigilance and investigate concealed sources of glucocorticoids in patients presenting with secondary adrenal insufficiency. Presentation: Sunday, July 13, 2025