Adrenal suppression following herbal remedy for rheumatoid arthritis

South Asian Endocrinology: Challenges and Concerns, Collaboration and Consolidation

The practice of endocrinology in South Asia poses many challenges but simultaneously offers unique opportunities. The population in this region is predisposed to diabetes and cardiovascular disease at a much lower body mass index compared to Caucasians. Dietary deficiencies, higher prevalence of infection and distinct environmental and genetic factors further complicate the presentation of endocrine disorders. Over the past few decades, important breakthroughs have been made to confront these challenges. Collaboration among the endocrine fraternity of the South Asian countries will help to consolidate these gains and pave the way forward for a healthier region.

Diffuse White Adipose Tissue 18F-FDG Uptake-An Unusual Finding on 18F-FDG PET/CT

ABSTRACT

Brown adipose tissue of cervical, supraclavicular, and paravertebral regions can show increased FDG uptake. But human white adipose tissue (WAT) shows negligible FDG uptake on 18F-FDG PET/CT scan. We present a case of carcinoma cervix treated with concurrent chemoradiation. 18F-FDG PET/CT shows altered biodistribution of FDG with intense FDG uptake throughout the WAT. Later on, patient confirmed taking herbal medication for herpes zoster infection, which could contain corticosteroids, resulting in enhanced WAT uptake of 18F-FDG.

Acute adrenal failure: a potentially fatal consequence of an adulterated herbal remedy

Herbal remedies adulterated with glucocorticoids can cause Cushing's syndrome. We report a severe presentation of a 'herbal remedy' adulterated with glucocorticoids; causing a potentially fatal adrenal crisis precipitated by acute illness. Investigations were consistent with adrenal suppression and confirmed, after tablet analysis, to be due to a 'herbal remedy' containing synthetic betamethasone/dexamethasone. This case highlights the need for clinical vigilance and patient education about the potential risks associated with the use of unlicensed treatments and the role of tablet analysis in routine biochemistry.

It is Time to Carpe Diem with Porcine ACTH - A Comparison of Porcine Sequence Corticotropin to Tetracosactide Hexaacetate in Testing the Hypothalamic Pituitary Adrenal Axis in Healthy Individuals

CONTEXT

Our literature search revealed that the use of porcine sequence corticotropin has not been validated against tetracosactide hexaacetate in a healthy population.

AIMS

To study the efficacy of using porcine sequence corticotropin in comparison with tetracosactide hexaacetate in the evaluation of hypothalamo pituitary adrenal (HPA) axis.

MATERIALS AND METHODS

Fifteen healthy volunteers were enrolled. Serum cortisol was measured at 0 minute in all subjects and at 30 and 60 minutes after tetracosactide hexaacetate 250 μg intravenously. Four weeks later, serum cortisol level was measured at 0 minute and at 30 and 60 minutes following 24 units of porcine sequence corticotropin given intramuscularly.

RESULTS

Mean serum cortisol values with tetracosactide were 30.3 (±7.83) μg/dl and 31.27 (±7.36) μg/dl at 30 and 60 minutes, respectively. The mean cortisol values with porcine sequence corticotropin were 26.33 (±5.47) μg/dl and 31.59 (±6.40) μg/dl at 30 and 60 minutes, respectively. All subjects had a response qualified as normal or adequate at 30 minutes itself. Mean peak serum cortisol response was 32.65 (±7.76) μg/dl in tetracosactide group and 31.59 (±6.4) μg/dl in porcine sequence corticotropin group, and the responses in two groups were comparable (P = 0.686). There were no immediate side effects in both groups, with a lower cost of procedure in the porcine corticotropin group.

CONCLUSION

Our study established the efficacy of porcine sequence corticotropin in testing the adequacy of HPA axis in healthy individuals. Our study also revealed that, the intactness of the HPA axis could be confirmed as early as 30 minutes in healthy individuals.