Exogenous Cushing´s syndrome with a difficult diagnosis

Abstract

Introduction: Cushing´s syndrome (CS) is a group of signs and symptoms caused by chronic exposure to excessive glucocorticoids. The use of medications containing glucocorticoids is the most common cause, but they may be hidden in some products sold as nutritional supplements or naturopathic medications, which makes the diagnostic approach more difficult.

Case presentation: this was a 40-year-old patient with typical clinical signs of Cushing´s syndrome and discordant results of diagnostic tests to identify its origin. It was ultimately determined that the patient had been chronically taking a "naturopathic" product known as Artrin®, which was analyzed in the institution"(TM)s lab and found to contain cortisol.

Conclusion: chronic exposure to exogenous glucocorticoids, whether surreptitious, unknown or prescribed, causes CS and should be promptly distinguished from endogenous forms to avoid inappropriate diagnostic tests and treatments.