Lethal doses
The supplements were: Artri King, Nhan Sam Tuyet Lien and Linsen Double Caulis Plus. According to the Food and Drug Administration, all are known to contain unlisted glucocorticoids. And the hospital's testing of two of the man's supplements confirmed the presence of the steroids.
Doctors determined that the man had actually overdosed on glucocorticoids; he had taken doses that exceeded the normal amount of glucocorticoids in the body. The steroids likely suppressed immune responses, leading to his infections and gastrointestinal ulcers. But more importantly, the excess steroid levels also effectively shut down his HPA axis. While it is possible to get the HPA axis working again after stopping excessive steroid use, the amount of time it takes can vary. Furthermore, it can lead to an adrenal crisis if a person stops taking large doses of glucocorticoids abruptly, rather than gradually (as in men) and especially after chronic use (also in men). In retrospect, the man showed all the signs of a crisis.
The doctors started treating him with hydrocortisone (the drug cortisol) to get him out of the danger zone. But it took six weeks for his HPA axis to show signs of recovery on tests. By then he had developed recurrent bacterial infections in his blood and persistent delirium. Only after several months in the hospital could he be discharged home.
Ultimately, doctors described the man's case as a cautionary tale. Many Americans use supplements, but their effectiveness is largely unproven and there are no strict regulations on their safety. And although the FDA in this case had specifically issued warnings about the three supplements the man was taking, his case highlights that public awareness of such dangers remains low.
“Physicians should remain vigilant when assessing supplement use and educate patients about potential risks, especially regarding hidden glucocorticoids, to prevent serious health complications such as adrenal insufficiency,” the doctors concluded.
