Abstract
Disclosure: M. Gonzalez: None. J. Guarneros: None. L.M. Cobos: None.
Background: Over-the-counter (OTC) medications from Mexico, particularly those marketed as pain relievers, anti-inflammatory agents, and herbal supplements, have increasingly come under scrutiny due to the presence of hidden steroids. These steroids, commonly added to enhance the efficacy of these products, pose significant health risks, especially because consumers are most of the time unaware of the medication’s contents. As a result, many patients are exposed to prolonged glucocorticoid use, increasing their risk of worsening metabolic disorders and developing hypercortisolism and even tertiary hypercortisolism once they stop its use, leading to severe and potentially life-threatening complications. Clinical Case: We report six cases of drug-induced hypercortisolism identified at an endocrinology clinic. These patients initially sought at our clinic for weight gain, worsening diabetes, and for concern for Cushings in the setting of a low Cortisol. During their evaluation, clinically signs and symptoms suggestive of hypercortisolism were present. Notably, all patients had been using over-the-counter supplements from Mexico. Their names are "RM Flex, Omega XL, Ultra Advance, and Arthri King." Patients were taking these supplements primarily for joint aches, which would be greatly improved with these supplements. These supplements did not advertise they contained glucocorticoids and laboratory evaluation for synthetic glucocorticoids was not available, however, clinically patients were cushinoid, biochemically their Pituitary-Adrenal axis was suppressed while taking these supplements and recovered once stopping them, and upon stopping these supplements, clinically they developed glucocorticoid withdrawal syndrome symptoms. After informing patients of the danger of the hidden glucocorticoid, some needed to be transitioned to a glucocorticoid and then wean them off, however, others decided to continue taking this despite informing them of the dangers excess glucocorticoids will lead to due the unbearable pain they get when discontinuing them. Conclusion: Addressing this public health issue requires increased awareness and education about the risks associated with unregulated OTC medications, particularly for populations along the U.S.-Mexico border where these products are more accessible. Although these medications are effective for pain relief, their side effects profile is much more dangerous, and their availability through online websites puts not only the border but the whole country in danger of developing secondary hypercortisolism. As healthcare providers, we have to do a better job of educating our patients about foreign and online supplements, and only through counseling and shared medical decision-making can we make a positive change in our patients.
Presentation: Saturday, July 12, 2025