SAT-433 Glucocorticoid-Containing Supplements Causing Severe Adrenal Insufficiency in Hospitalized Patients: A Case Series

Abstract Disclosure: G. Herrington: None. S. Abouzaglo: None. E. Chapa: None. C. Helm: None. O. Hamidi: None. J. Sutaria: None. Background: Exogenous glucocorticoid (GC) use in the general population is estimated to be ∼1-3%. Surreptitious GC-containing supplements place patients at risk for GC-induced adrenal insufficiency (AI) via suppression of hypothalamic-pituitary-adrenal axis (HPA). Objective: To describe clinical outcomes in hospitalized patients taking GC-containing supplements, and to determine factors associated with the development of GC-induced AI. Methods: In this retrospective longitudinal cohort study, we identified adult patients (≥18 years) who were taking GC-containing supplements and hospitalized in our center between 2013 and 2023. We assessed initial presentation at hospitalization, adrenal crisis rate, and factors associated with the development of GC-induced AI. Results: 19 patients (median age 59 years [range, 35-74], 57.8% women) who reported taking GC-containing supplements were hospitalized at our center during the study period. Supplements included: Artri King (n=11), Ardosons (n=5), AK Forte (n=1), Ortiga Mas Ajo Rey (n=1), and Rumoquin (n=1). All (100%) patients reported using the supplements for joint pain related to osteoarthritis, gout, or rheumatoid arthritis. 15 (79%) patients were diagnosed with GC-induced AI based on clinical and biochemical data. The median self-reported duration of supplement use was 24 months (IQR, 12-36). The median early morning serum cortisol value was 2.25 mcg/dL (IQR, 1-3.25) and ACTH was 5 pg/mL (IQR 1.85-10). 12 (63%) patients had Cushingoid features. Of 15 patients with GC-induced AI, all presented with Grade 3 (60%, severe) or Grade 4 (40%, life-threatening) AI symptoms, as per CTCAE Grading. 5/15 (33.3%) had adrenal crisis at the time of index hospitalization. 4/15 (26.7%) patients with GC-induced AI required intensive care unit admission. GC-attributable complications during hospitalization were noted in 79% of patients, including severe anemia, acute kidney injury, and shock. Factors associated with GC-induced AI were: female sex (73.3% with AI vs 0% without AI, P=0.008), Cushingoid features (80% vs 0%, P=0.003), and higher Clinical Disease Severity score for Cushing syndrome (13 vs 1.5, P= 0.006). At study conclusion, only 4 (26.7%) patients recovered HPA axis. Median duration of follow-up was 21.3 month (IQR, 11.3-37.5). Conclusions: Surreptitious GC-containing supplements targeted to alleviate joint pain can cause severe GC-induced AI and adrenal crisis (upon abrupt cessation). Female sex, Cushingoid features, and higher Clinical Disease Severity Score were associated with the development of GC-induced AI. We observed high incidence (33.3%) of adrenal crisis in our hospitalized cohort, in contrast to previous data suggesting low risk for adrenal crisis in patients with GC-induced AI. Surreptitious GC exposure should be considered for inpatients presenting with Cushingoid features and symptoms concerning for AI. Presentation: Saturday, July 12, 2025