SUN-060 A Case of Artri King Induced Hypothalamic-Pituitary-Adrenal Axis Disorder

Abstract Disclosure: A. Safdar: None. S.I. Alqaisi: None. Introduction: Cushing syndrome, a hormonal disorder characterized by excess of endogenous or exogenous corticosteroid hormones in the body, presents with wide range of symptoms, including weight gain, elevated blood pressure, and muscle weakness. There is growing evidence that supplements containing unregulated amounts of steroid can lead to this presentation (1). Artri King, an over the counter supplement advertised to treat arthritis, has been implicated as a cause of iatrogenic Cushing syndrome and concomitant adrenal insufficiency because of its dexamethasone content not listed on its label (3). Herein, we chronicle a case of Cushing syndrome related to use of Artri King. Case: Our patient was a 24 years old female with past medical history juvenile idiopathic arthritis who reportedly had been off all medications for the last one year and presented with worsening back pain, left hip pain, joint pain, weakness, and inability to ambulate. In addition she reported 100 pounds weight gain in the last in year. Her clinical exam revealed features consistent with Cushing syndrome including moon facies, central obesity, and skin striae. There was initial concern for discitis or other spine infection for which she underwent MRI and other infectious workup that all resulted as negative. Upon further inquiring, she endorsed using two tables of supplement “Artri King” for the last one year to relieve her joint pains. Her ACTH was 5 pg/ml (reference 6-50 pg/ml) and am cortisol level was 1.87 ug/dL (reference 5.27-22.45 ug/dL) consistent with suppressed pituitary-adrenal axis secondary to exogenous steroid use. She was advised to stop Artri King Supplement, adrenal education was provided and she was discharged with hydrocortisone supplements to take in the event of acute illness or surgery with close outpatient clinic follow-up. Discussion: Artri King is a supplement marketed for joint pain and arthritis. Chronic use of Artri King or similar products containing undisclosed glucocorticoids can lead to iatrogenic Cushing syndrome and secondary adrenal insufficiency and even predispose to life-threatening adrenal crisis. There are only a handful of documented cases of Artri King related Cushing syndrome (1). Atri King contains diclofenac and dexamethasone not listed on the product's label, and the US Food and Drug Administration released a public notification in 2022, advising consumers not to use or purchase it. This case emphasizes the need for increased awareness among health care professionals and public about the potential risks associated with unregulated supplements. References: Berg EA, Dao L, Yu R, Hurtado C. Artri King-induced Hypothalamic-pituitary-adrenal Axis Disruption: A Report of 3 Cases. JCEM Case Rep. 2023 Dec 19;2(1):luad154. doi: 10.1210/jcemcr/luad154. PMID: 38116163; PMCID: PMC10729854. Presentation: Sunday, July 13, 2025