Exogenous Cushing’s syndrome tied to Artri King supplement: Report

Case underscores need for 'tighter control' of over-the-counter products

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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A 40-year-old woman developed exogenous, or therapy-related, Cushing’s syndrome, after taking an over-the-counter supplement called Artri King that contained undisclosed glucocorticoids, a case study reports.

The woman’s symptoms eased after she stopped taking the supplement, but this is the third study to report an association between products like Artri King and Cushing’s syndrome.

“Given the increased use and availability of [over-the-counter] supplements, this case highlights on the importance of detailed history-taking and the role of supplements in causing [Cushing’s syndrome],” the researchers wrote, adding it underscores the need to educate patients about the products they choose and for “tighter control” of supplements’ manufacture and sale.

The study, “Exogenous Cushing Syndrome and Hip Fracture Due to Over-the-Counter Supplement (Artri King),” was published in Cureus.

Exogenous Cushing’s syndrome is caused by excessive or long-term exposure to certain medications, usually glucocorticoids. While these medications are often prescribed for various inflammatory conditions, being accidentally exposed to glucocorticoids in supplements purchased over the counter may also lead to developing the disease.

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Artri King supplement is source of Cushing’s symptoms

Researchers at the University of Central Florida College of Medicine, Orlando wrote about a woman who developed Cushing’s after taking a supplement for joint pain and arthritis called Artri King, which was blended with glucocorticoids.

The woman, who was deemed obese, was hospitalized after a fall, but began having pain in her right hip for several days before that. A CT scan confirmed a fracture in her right femur (thigh bone). She had surgery to stabilize and help heal the break.

In the previous five months, she’d gained around 40 pounds for no apparent reason, reaching 223 pounds. At her hospitalization, she denied taking any medications or supplements. On admission, her vital signs were normal and a physical exam showed no signs of abdominal stretch marks, fat accumulation in the upper neck, or muscle weakness.

Blood work showed reduced 25-hydroxy vitamin D levels and elevated levels of parathyroid hormone (PTH), suggesting secondary hyperparathyroidism due to vitamin D deficiency. Hyperparathyroidism occurs when the parathyroid glands become overactive and release too much PTH, causing calcium levels to rise. The woman’s calcium levels were normal, however.

More exams confirmed she had osteoporosis, which causes bones to become weaker and more prone to fracture. At this point, clinicians began to suspect her symptoms were the result of excessive cortisol, a steroid hormone normally produced by the adrenal glands.

Her cortisol levels were low, however, and other adrenal steroid hormone levels were too. The woman was given teriparatide (brand name Forteo), an artificial form of PTH, to treat her osteoporosis, along with vitamin D and calcium.

Due to her symptoms, she was asked again about taking steroids. This time, the patient recalled taking Artri King as a supplement to ease joint pain and arthritis. She’d been taking two tablets of it, three times daily, on and off for the past three years.

“The patient neglected to bring it to the medical team’s attention before because she was under the impression that it was a multivitamin and did not have implications on her diagnosis,” the researchers wrote.

The woman was advised to stop taking the supplement and was informed about the potential symptoms of impaired adrenal gland function and glucocorticoid withdrawal.

Blood work taken four weeks after stopping Artri King showed her cortisol levels had begun to recover and she’d lost 25 pounds. The woman continued taking teriparatide and a bone mineral density test was planned.

“In conclusion, we recommend that a thorough reconciliation of medication and supplements be obtained for all patients with [Cushing’s syndrome],” the researchers wrote.