Speaker Credentials
MS-III
Speaker Credentials
MS
College
College of Allopathic Medicine
Medical Specialty
Internal Medicine
Format
Poster
Start Date
November 2024
End Date
November 2024
Track
3
Abstract
Introduction: Cushing syndrome, resulting from hypercortisolism, can be caused by both exogenous glucocorticoid use and endogenous production. While exogenous Cushing Syndrome is usually associated with known glucocorticoid exposure, the risk of occult use through over-the-counter (OTC) supplements is a growing concern. Case Presentation: 60-year-old male presented to the ED with worsening dyspnea, bilateral lower extremity swelling, and intermittent chest pain. He was admitted for suspected congestive heart failure (CHF) exacerbation. Medical history includes obesity, hypertension, diabetes, and CHF. On day 2, a Cushinoid appearance was noted on physical exam with BLE muscle wasting, round faces, and prominent central obesity with abdominal purple striae. The patient admitted to taking the supplement Artri King for joint pain for the past year, which contained undisclosed dexamethasone. Labs revealed cortisol of 0.67 mcg/dL and an ACTH of 2.7 pg/mL. Deviation From Expected: This case underscores the risk of unregulated supplement use and the need for thorough investigation in patients with complex presentations. Discussion: A detailed exploration of the patient's clinical presentation and research into Artri King were crucial for diagnosis. Prednisone 60 mg daily was initiated with a plan for gradual tapering to prevent adrenal insufficiency. Additionally, his complex history of comorbidities required careful management by a multidisciplinary team. Conclusion: Diagnosing Cushing Syndrome can be challenging, especially in patients with multiple comorbidities, emphasizing the need for thorough investigation to identify potential iatrogenic sources. Early recognition and management are essential to prevent complications, and providers should educate patients about the risks associated with OTC supplements.
Poster
Be Suspicious of Supplements: A Case of Exogenous Cushing Syndrome from Hidden Ingredient
Introduction: Cushing syndrome, resulting from hypercortisolism, can be caused by both exogenous glucocorticoid use and endogenous production. While exogenous Cushing Syndrome is usually associated with known glucocorticoid exposure, the risk of occult use through over-the-counter (OTC) supplements is a growing concern. Case Presentation: 60-year-old male presented to the ED with worsening dyspnea, bilateral lower extremity swelling, and intermittent chest pain. He was admitted for suspected congestive heart failure (CHF) exacerbation. Medical history includes obesity, hypertension, diabetes, and CHF. On day 2, a Cushinoid appearance was noted on physical exam with BLE muscle wasting, round faces, and prominent central obesity with abdominal purple striae. The patient admitted to taking the supplement Artri King for joint pain for the past year, which contained undisclosed dexamethasone. Labs revealed cortisol of 0.67 mcg/dL and an ACTH of 2.7 pg/mL. Deviation From Expected: This case underscores the risk of unregulated supplement use and the need for thorough investigation in patients with complex presentations. Discussion: A detailed exploration of the patient's clinical presentation and research into Artri King were crucial for diagnosis. Prednisone 60 mg daily was initiated with a plan for gradual tapering to prevent adrenal insufficiency. Additionally, his complex history of comorbidities required careful management by a multidisciplinary team. Conclusion: Diagnosing Cushing Syndrome can be challenging, especially in patients with multiple comorbidities, emphasizing the need for thorough investigation to identify potential iatrogenic sources. Early recognition and management are essential to prevent complications, and providers should educate patients about the risks associated with OTC supplements.