Adrenal suppression following herbal remedy for rheumatoid arthritis

Premkumar, Balasekar; Murthy, M. Srinivasa; Rajagopal, Karuppasamy; Prabu, Vnn; Ponugupati, Sree Madhuri

doi:10.4103/0976-500x.155493

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…A variety of herbal remedies and exogenous glucocorticoids used for long duration in treatment of rheumatoid arthritis and other chronic conditions can lead to HPA axis suppression. [ 15 ] However, HPA axis suppression with exogenous steroids is dependent on dose, route of administration and duration of treatment which produces a variable picture in clinical presentation. Generally, HPA axis recovers in 6–12 months; however, cases with delayed recovery up to 18 months have been reported.…”

Section: Discussionmentioning

confidence: 99%

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

Wagmode

Mathew

Bantwal

et al. 2018

Indian J Endocr Metab

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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.

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Section: Discussionmentioning

confidence: 99%

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

Wagmode

Mathew

Bantwal

et al. 2018

Indian J Endocr Metab

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“…Recently published study by Young et al 8 reported these findings in a patient with T-cell lymphocytic lymphoma treated with high-dose l -asparaginase chemotherapy 3 hours before the scan. Previous reports have suggested that herbal medicines, 2,9 such as the one taken by our patient for her herpes infection, could contain corticosteroids, resulting in enhanced WAT uptake of 18 F-FDG. There was no history suggestive of antiretroviral therapy, chemotherapy containing corticosteroids, intravenous insulin, or ascorbic acid administration before scan, which have been reported as causes of enhanced WAT uptake of 18 F-FDG.…”

mentioning

confidence: 70%

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

et al. 2021

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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.

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“…In Thailand, almost half the patients with AI reported a history of unprescribed over-the-counter herbal/traditional medicine use [ 19 ]. Studies have documented that some herbal/traditional medicines have been intentionally adulterated with glucocorticoids [ 20 , 21 ]. Some Thai patients believe that these products are safe as they are prepared from natural materials and have been used by humans for many generations.…”

Section: Discussionmentioning

confidence: 99%

Is Preoperative Adrenal Insufficiency Screening Necessary for Cardiovascular Thoracic Surgery Patients?

Manosroi

Atthakomol

2023

Medicina

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Background: The association between adrenal insufficiency (AI) and the treatment outcomes of cardiothoracic surgery patients has been little reported. The aims of this study were to investigate the incidence of AI and to compare the post-surgical outcomes of patients with perioperatively treated AI and patients with a normal adrenal response. Methods: A 1.5-year prospective study was conducted in 98 patients scheduled for cardiothoracic surgery. Patients were categorized as either AI or normal-adrenal-response patients. Those with AI were treated with stress doses of glucocorticoid perioperatively. The post-surgical outcomes of patients with AI and of those with a normal adrenaline response were analyzed using multivariable analysis. Results: The overall incidence of AI was 34.7%. There were no statistically significant differences in post-surgical outcomes, including prolonged hospital stay, postoperative infection, prolonged inotropic drug use and relative AI, between the two groups. Only the rate of hyperglycemia requiring insulin infusion was significantly higher in the AI group than in the non-AI group (OR = 14.15, 95% CI = 1.44–138.60, p = 0.02). Conclusions: The proper diagnosis and management of AI can result in surgical outcomes in AI patients comparable to those of normal-adrenal-response patients. Non-life-threatening hyperglycemia requiring insulin infusion was found only in the AI group.

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Adrenal suppression following herbal remedy for rheumatoid arthritis

Cited by 5 publications

References 5 publications

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

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

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

Is Preoperative Adrenal Insufficiency Screening Necessary for Cardiovascular Thoracic Surgery Patients?

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