Endocrine Abstracts

Case Presentation: A 35-year-old Caucasian male presented to our endocrine clinic with a right pituitary lesion. This was found incidentally on MRI nine months previously after admission with head injury. He was asymptomatic apart from intermittent pain in his left wrist and right knee. He has a history of epilepsy. He was on paracetamol for analgesia, levetiracetam for epilepsy, and was not on any oral, topical, inhaled or injectable steroids. On assessment, he had central obesity with lower abdominal striae. He was otherwise euthyroid and eupituitary and did not complain of headaches or visual disturbances. Hormone profile revealed a low serum cortisol and ACTH. He was also found to have low testosterone but normal levels of gonadotrophins. These findings remained consistent on repeat testing.

Management: The patient was temporarily started on hydrocortisone replacement therapy. The case was then discussed at the endocrine MDT which gave the impression that the picture was consistent with exogenous steroid use and so hydrocortisone was stopped. However, no clear source of steroids could be identified. With further probing, the patient shared that he was using Thai herbal tea daily for analgesia and agreed to a trial off the tea. Serum cortisol and ACTH levels returned to normal thereafter on serial testing. As such the tea was suspected as the source of exogenous steroids.

Conclusion: Literature supports the steroid-like effects of traditional/natural remedies. It has been suggested that some natural products have innate steroid-like effects, whereas other products are in fact corticosteroids masquerading as ’natural’ remedies. This case highlights a potentially interesting dietary source of steroids that clinicians may encounter in their practice. Additionally, if a patient presents with adrenal insufficiency or Cushingoid features alongside natural remedy use, it would be wise to investigate further.