Deadly doses
The supplements were: Artri King, Nhan Sam Tuyet Lien, and Linsen Double Caulis Plus. All are known to contain unlisted glucocorticoids, according to the Food and Drug Administration. And testing of two of the man’s supplements by the hospital confirmed the presence of the steroids.
Doctors determined that the man had essentially overdosed on the glucocorticoids—he had taken doses that exceeded the normal levels of glucocorticoids in the body. The steroids likely suppressed immune responses, leading to his infections and GI ulcers. But, more significantly, the excess steroid levels also caused his HPA axis to essentially shut down. While it’s possible to get the HPA axis back up and running after withdrawal from excessive steroid use, the amount of time that takes can vary. Further, if a person stops taking large doses of glucocorticoids abruptly, rather than gradually—as in the man’s case—and particularly after chronic use—also as in the man’s case—it can lead to an adrenal crisis. In retrospect, the man had all the signs of a crisis.
The doctors started treating him with hydrocortisone (medication cortisol) to get him out of danger. But it took six weeks before his HPA axis showed signs of recovery on tests. By that time, he had developed recurrent bacterial infections in his blood and had persistent delirium. It was only after several months in the hospital that he was able to be discharged back home.
In the end, the doctors describe the man’s case as a cautionary tale. Many Americans use supplements, but their efficacy is largely unproven, and they are not rigorously regulated for safety. And even though, in this case, the FDA had issued warnings specifically about the three supplements the man took, his case highlights that public awareness of such dangers remains low.
“Clinicians must remain vigilant in assessing supplement use and educate patients on potential risks, particularly regarding hidden glucocorticoids, to prevent serious health complications such as adrenal insufficiency,” the doctors conclude.
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