Cushing’s syndrome linked to Artri King in latest report

Patient developed adrenal insufficiency after abruptly stopping supplement

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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A 52-year-old man developed Cushing’s syndrome after taking Artri King, adding to the list of reports that link the supplement to developing the condition.

The man had been taking Artri King for his arthritis for 1.5 years, but abruptly stopped after having Cushing’s-like symptoms. His abrupt cessation is believed to have triggered adrenal insufficiency, a condition where the adrenal glands fail to produce enough of certain hormones, including cortisol. Artri King contains glucocorticoids.

The case “illustrates the consequence of allowing dietary supplements to be sold before [a U.S. Food and Drug Administration] evaluation as well as the importance of physicians eliciting history of supplement use and offering a culturally competent discussion with their patients regarding supplement use,” researchers  at Stanford University wrote in “A case of iatrogenic Cushing syndrome and subsequent adrenal insufficiency from a hidden ingredient in the supplement Artri Ajo King,” which was published in the Journal of the American College of Emergency Physicians Open.

A feature of Cushing’s syndrome is excessive levels of the hormone cortisol, which is normally produced by the adrenal glands. The condition can be triggered by excessive or long-term exposure to certain medications, usually glucocorticoids, which act like cortisol in the body. This form of the syndrome is often referred to as iatrogenic, or treatment-related Cushing’s syndrome.

The man, whose medical history included high blood pressure (hypertension), high levels of fatty molecules in the blood, prediabetes, and arthritis, visited the emergency department complaining of abdominal pain, nausea, and vomiting. The symptoms had lasted for more than a month.

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Symptoms develop after stopping Artri King

He was on a liquid diet because he was unable to tolerate solid foods and had lost 20 pounds. His bowel movements were normal, but he needed a walker due to muscle weakness. Previous visits to the emergency department had failed to identify the cause of his symptoms.

The man said he’d recently stopped taking Artri King after being hospitalized and his symptoms arose around that time. He’d been taking the supplement for 1.5 years for his arthritis, during which time, he’d gained 50 pounds, developed fat accumulation in his neck, abdominal striae, face rounding, and muscle weakness — all signs of Cushing’s syndrome.

His vital signs were normal, but a physical examination showed tenderness to palpation in the upper region of his abdomen.

A neurological evaluation confirmed muscle weakness and blood work showed his potassium and magnesium levels were low, while his calcium levels were slightly elevated. An abdominal CT scan revealed a fat-filled hernia in the belly button and fat accumulation in the liver. He was hospitalized and given fluids intravenously (into the vein).

In the morning after being hospitalized, blood work showed his cortisol levels were low (1.2 micrograms per deciliter, mcg/dL; normal range above 2 mcg/dL), but his ACTH levels were normal (32.2 picograms per milliliter, pcg/mL; nomal range 7.2-63.3 pcg/mL).

The man’s ability to produce cortisol following stimulation with cosyntropin was assessed. Cosyntropin is a man-made form of the adrenocorticotropic (ACTH) hormone that normally stimulates the adrenal glands to produce cortisol. His cortisol levels rose from 1.4 to 8.6. mcg/dL.

The findings were consistent with adrenal insufficiency due to the disruption of the signaling cascade that controls cortisol production as a result of stopping Artri King. Adrenal insufficiency is a common complication of chronic glucocorticoid use.

He was started on a steroid regimen, which alleviated his symptoms, and was discharged on hydrocortisone, a corticosteroid, 15 mg in the morning and 910 mg in the afternoon.

“Physicians are strongly encouraged to report cases such as this to the FDA’s MedWatch to ensure appropriate action is taken to regulate and prevent harm to patients,” the researchers wrote.