Endocrine Abstracts

A 29-year-old lady with known Addison’s disease and hypothyroidism was admitted with a history of increasing lethargy and dizziness for 2 weeks. At the time of admission she was on (and compliant with) Hydrocortisone 20 mg twice daily, Fludrocortisone 100 mcg once daily and Thyroxine 150 mcg once daily. On the day of admission her BP was 128/92 mmHg with no postural drop. Her electrolytes were normal, however an early morning cortisol measured 28 mmol/l. She was treated with IV Hydrocortisone for 24 hrs following which she was changed to oral Hydrocortisone. She was discharged after 3 days on Hydrocortisone 10, 10, 5 mg and Fludrocortisone 100 mcg once daily.

Unfortunately she was readmitted 7 days later. Her symptoms included postural dizziness and pins and needles over her face. During this admission her blood pressure was 136/97 mmHg lying and 118/97 mmHg sitting. Her electrolytes were again normal. She was treated with IV Hydrocortisone for the first 24 hrs and Endocrinology review requested. On further questioning, it was noted that the only change in her medication within the last few weeks was use of ‘Wellbeing Detox Patches’. She denied any previous Addisonian crisis and had been very well controlled previously on oral steroids. On stopping the patch, her steroid replacement has since been unproblematic

Discussion: Detox patches contain multiple natural ingredients (up to 15 different ‘natural’ products). They are sold on the pretext that they ‘cleanse’ the body of harmful by-products. Others are said to stimulate acupuncture points through action of wood/bamboo vinegar, far infrared (a form of safe radiated energy) or minus ion emissions (formed naturally).

Herbal medicines may contain several enzyme inducers that metabolise cortisol leading to hypocortisolaemia and crisis. Subjects on steroid replacement should be warned about the usage of over-the-counter medicines even those thought to be ‘natural remedies’.