Exogenous Cushing Syndrome Associated With Homeopathic Cream (Boswellia Serrata)

Abstract

Background: Cushing syndrome (CS) includes the signs and symptoms associated with prolonged exposure to abnormally elevated plasma levels of glucocorticoids, which can be either exogenous or endogenous (cortisol). Exogenous CS has been associated with homeopathic and allopathic products with anti-inflammatory properties, has been demonstrated in many of them, that there are steroid contributions in these drugs which are not reported in their inserts and in prolonged exposure generate BMS. Clinical Case: We present the case of a 23-year-old female with a history of polycystic ovarian syndrome in management with ciproterone acetate and metformin 500 mg dia, who has gained 12 kilos of weight in two months, Progressive appearance of violaceous stretch marks on the thighs, arms and abdomen, associated with diaphoresis, hyporexia, acneiform, rash and hirsutism. The symptoms were related to the use of natural anti-inflammatory cream, for joint pains in knee and shoulders based on natural extracts of Boswellia Serratia during the last three months. It presents paraclinics with post-dexamethasone serum cortisol levels in 1. 25, ACTH 1. 5, Urinary cortisol 20. 24 ug/24h, urinary volume 0. 88 L/24H, DHA -S 27. 1Ug/dl, Free testosterone <0.24 pg/ml, TSH 2. 59 ng/dl, Free-T4: 1. 16 ng/dl, Prolactin: 31 Ng/ml (0–23), Somatomedin C: 109 Ng/ml, (92.9–342.0), HBAC1: 5. 37%, preprandial and postprandial glycemia: 90–133 mg/dl, Am Cortisol:1.11 mcg/dl (6–18 Mcg/dl), Basal Insulin: 74 uUI/ml., Postprandial Insulin: 57 uUI/ml. Clinical findings and dynamic biochemical studies of the adrenal axis, with a positive dexamethasone suppression test and no findings suggesting ectopic production; it was confirmed that the diagnosis of exogenous CS is associated with the use of topical anti-inflammatory. With the of the drug’s suspension, clinical findings have improved, and cortisol levels have decreased. Conclusion: Exogenous hypercortisolism associated with the use of topical anti-inflammatory drugs is not frequent. The first case reported an association with the use of a topical drug based on Boswellia Serrata. In conclusion, with the presence of signs and symptoms of CS the recent use of herbal products by any route of administration and by excluding other causes of endogenous hypercortisolism (central or ectopic) and exogenous, the use of homeopathic products should be suspected as an etiology. Nowadays, there are no reports of exogenous Cushing by BS. The first case is described, without omitting the possibility of unknown compounds in the topical preparation.