Q: 48-year-old Chinese female is admitted to ICU with hypertensive crisis. The patient appears with classic signs of Cushing syndrome like moon face, supraclavicular fat pads, buffalo hump, truncal obesity, and purple striae. Endocrinology service is consulted and patient indeed get diagnosed with Cushing syndrome with probable iatrogenic cause. To your surprise, while taking history, patient drug list does not include any glucocorticoids. Which one part of the history may help to find the missing piece of the puzzle?


Answer: History of herbal intake

Many herbal preparations contain corticosteroids and they often go unnoticed during history taking. In such cases, there should be a gradual withdrawal and discontinuation of the causative drug.