Abstract

Background: This is a case report of a patient who presented in adrenal crisis after the abrupt cessation of a supplement, Artri King®, which is marketed for the treatement of joint pain. Artri King® was the subject of a 2020 Food and Drug Administration (FDA) advisory due to the product containing undisclosed dexamethasone, diclofenac, and methocarbamol.
Case report: This patient used Artri King® daily for 2 years to manage her chronic joint pain and abruptly stopped, yielding a presentation of hypotension that was unresponsive to aggressive fluid resuscitation and initiation of peripheral vasopressors. The patient’s blood pressure stabilized after stress-dose steroids were given and peripheral vasopressors were up-titrated.
Why should an emergency physician be aware of this?
To our knowledge, this is the first case of a patient developing adrenal shock after discontinuing a health supplement that contains undisclosed corticosteroids. This case shows the broad presentation of adrenal crisis and emphasizes the importance of asking about the use of over-the-counter supplements when evaluating patients.

Keywords

adrenal crisis, adrenal insufficiency, Artri King®, Cushing syndrome, Cushingoid