SAT435 The Quest Of Elevated Dhea-s: Is It A Tumor Or Is It Ashwagandha?

Abstract

Abstract Disclosure: S. Patel: None. O.A. Aluko: None. T. Gallagher: None. Introduction: Ashwagandha (Withania somnifera) is a popular Indian ayurvedic herb that is readily available over the counter in the United States. Ashwagandha is known to increase in testosterone and DHEA-s levels in men. We hereby report a case of a female who had elevated DHEA-s due to intake of Ashwagandha. Case Report: A 27 year old female with past medical history of vitamin D deficiency, anxiety, X linked heterozygous adrenoleukodystrophy presents to establish care with endocrinology with complaints of unintentional weight gain of about 25lbs, inability to lose weight with lifestyle modifications, dizziness, light headedness and occasional salt cravings. Medication history is significant for using ashwagandha 600mg twice daily, probiotic-10. Vitals were BP 102/70 mmHg, HR 108 beats/min, RR 18 breaths/min, SpO2 98%, BMI 31.28kg/m2. Laboratory evaluation showed AM cortisol of 21.6 ug/dL H (6.2-19.4 ug/dL), ACTH 6.2 pg/mL (7.2-63.3 pg/mL), DHEA-s >1000 ug/dL H (84.8-378 ug/dL), TSH 1.39 IU/mL (0.45-4.5 IU/mL), free t4 2.39 ng/dL H (0.82-1.77 ng/dL), IGF-1 252 ng/mL (91-308 ng/mL), 1mg dexamethasone suppression test resulted AM cortisol of 1.5 ug/dL (6.2-19.4 ug/dL). Subsequently, further work up revealed 17 hydroxyprogesterone of 158 ng/dL (luteal phase 35-290 ng/dL), total testosterone 176 ng/dL H (13-71 ng/dL), free testosterone 1.8 pg/mL (0-4.2 pg/mL), androstenedione 113 ng/dL (41-262 ng/dL), LH 2.5 mIU/mL (follicular phase 2.0-12.6 mIU/mL), FSH, 3.6 mIU/mL (follicular phase3.5-12.5 mIU/mL). Patient underwent CT abdomen and pelvis with and without contrast which showed normal adrenal glands, prominent right ovary and US Pelvis was recommended. Pelvic ultrasound showed normal ovaries. MRI pelvis with and without contrast revealed 1cm right ovarian hemorrhagic cyst. Patient was subsequently asked to stop all over the counter supplement medications and a DHEA-s level was checked about 6 weeks and was markedly reduced to 435 ug/dL. TSH and free t4 improved to 0.789 IU/mL and free t4 1.43 ng/dL respectively. Conclusion: This case highlights that over the counter, readily available supplements that are marketed for reducing stress may cause remarkable alteration of natural physiology. Ashwagandha’s use in men have been known to cause elevations in DHEA-s in men and this case highlights that Ashwagandha’s use in women can also cause elevation in DHEA-s and how a simple intervention of eliminating Ashwagandha can improve DHEA-s levels Presentation: Saturday, June 17, 2023