6665 A Case of Exogenous Cushing Syndrome and Acute Adrenal Insufficiency from Usage and Subsequent Withdrawal of Unregulated Glucocorticoid Supplement Ardosons

Abstract Disclosure: A. Rao: None. A.F. Ishola: None. D. Desai: None. D.E. Sellmeyer: None. Introduction: Exogenous Cushing’s syndrome is a frequent complication of therapeutic glucocorticoids. Rare cases of exogenous hypercortisolism from supplements have been reported. We report the first case of exogenous Cushing’s syndrome due to an unregulated anti-inflammatory supplement called Ardosons. Clinical Case: A 47-year-old male with medical history of ankylosing spondylitis, obstructive sleep apnea, and hypertension presented to the hospital with several weeks of generalized weakness. Five weeks prior to his admission, he was evaluated by Rheumatology and started on adalimumab for ankylosing spondylitis, and all previous medications were stopped.His medication history was notable for Ardosons, an unregulated supplement he obtained in Mexico for ankylosing spondylitis that contains 25 mg of indomethacin, 0.75 mg of oral betamethasone, and 215 mg of methocarbamol. He had been taking two tablets of Ardosons daily for the past ten years, and throughout this time had noted 160 lb weight gain, worsening hypertension, and development of obstructive sleep apnea.His symptoms on hospital presentation since stopping Ardosons included weakness, nausea, vomiting, and hypotension. Clinically, he appeared Cushingoid with violaceous striae, abdominal adiposity, prominent dorsoclavicular and supraclavicular fat pads, and scattered ecchymoses. Due to these exam findings, the medical team obtained a 1 mg dexamethasone suppression test which showed morning cortisol of 1.1 ug/dL [reference range post-suppression