[Pseudo-Cushing’s] Michigan woman nearly dies after herbal supplement found to be laced with steroids

MADISON HEIGHTS, Mich. (WXYZ) – Since 2004, the U.S. Food and Drug Administration has received more than 26,000 reports of adverse events and complaints about dietary supplements.

Jody Higgins of Madison Heights, Michigan made one of those complaints to the FDA, after she says she found out the herbs she had been taking were making her seriously ill.

“I really thought I was going to die I was getting so sick,” Higgins said.

Back in 2015, Higgins says her legs started hurting.  She says she didn’t have great health insurance, and she was hoping for a more holistic approach, so a friend referred her to Far East Ginseng Herbs and Tea in nearby Sterling Heights.

“They suggested that I take something that was called Linsen Double Caulis. I had never heard of it before, and it appeared to have all herbs on the label,” Higgins said.

Higgins says for a while, she felt better, and when she stopped taking the Linsen Double Caulis, the leg pain returned. So, she says she kept taking it for nearly a year, even though she started noticing strange symptoms.

“Within four months I had gained 80 pounds,” she said.

She suddenly had facial hair growth, severe facial swelling, extremely swollen ankles, and had dark purple stretch marks all over her body.

“I wasn’t recognizable,” said Higgins.  “I couldn’t stand for longer than 2 minutes. I couldn’t cook. I couldn’t wash my clothing. I could barely get in the shower.”

After visiting several doctors, Higgins was eventually referred to University of Michigan Endocrinologist Dr. Ariel Barkan.

“The minute that I said I had been taking a Chinese herbal remedy, he said ‘you’ve been poisoned. I know it.’ Those were his exact words,” said Higgins.

“Her situation was pretty shaky,” Barkan said.

Barkan sent the Linsin Double Caulis herbal supplement to the Mayo Clinic for testing.

“They were loaded with Dexamethasone … [which] is a medication.  It’s a synthetic steroid, very potent, very long acting, and if we take it for quite some time, we develop what is called Cushing Syndrome,” said Dr. Barkan.

Higgins was diagnosed with Cushing Syndrome, and Barkan says she could have died if she hadn’t sought help.

“The mortality for untreated Cushing Syndrome is 50% within 5 years,” said Barkan.  “ … immunity is completely suppressed. And when you don’t have immunity, the first virus, the first germ may cause [a] fatal infection and you will die.”

Higgins says once she stopped taking the Linsen Double Caulis, the facial hair went away, but she’s still struggling with her weight. Barkan says her health should improve, although it will take time.

Both doctor and patient say they have contacted the FDA about this, and they each have a warning about taking herbal supplements.

“Please just be very cautious,” Higgins said.

“Don’t touch it. Don’t touch it, you’re playing Russian roulette,” said Barkan.

Jody Higgins says she met with an investigator from the FDA’s criminal division.

An FDA spokesperson would only say that they do not discuss possible or ongoing investigations.

The lawyer for the store where Higgins says she purchased the supplement told us the owners will not be commenting on, but the owner did say they no longer sell this product.

From http://www.fox4now.com/news/national/madison-heights-woman-herbal-supplement-caused-life-threatening-illness

Woman diagnosed with Cushing’s syndrome

Thursday, May 05, 2016
AsiaOne

SINGAPORE – The Health Sciences Authority (HSA) has warned the public not to purchase or consume a health product labelled in Chinese as ‘Hai Leng Hai Beh Herbal Itch Removing Capsule’ after a customer consumed it and has now been diagnosed with a metabolic disorder known as Cushing’s syndrome.

In a press release today (May 5), the HSA revealed that a woman in her 40s, bought the capsules from a retail store overseas to ease an itchy skin condition after a relative’s recommendation.

Just a day after consumption her itchy skin condition improved. However after consuming the pills for two months, she gained weight rapidly and her face became puffy.

Evidence later showed that the pills were not entirely herbal in nature and contained “potent traces of steroid and painkillers like paracetemol”, according to HSA.

Dexamethsone, a steroid which is usually prescribed for inflammatory conditions, is known to cause increased blood glucose levels that cause diabetes, high blood pressure, cataracts and muscular and bone disorders when taken over a long period of time without supervision.

These medical conditions may, in turn, cause a consumer to develop Cushing’s syndrome, said HSA.

Chlorpheniramine was also found in the capsule. HSA said the antihistamine is commonly known to treat allergic reactions and can cause drowsiness, blurred vision, vomiting and constipation.

Paracetamol is known to cause swelling of the lips or face and rashes.

The HSA has advised all sellers to stop selling and distributing the capsules immediately.

If caught selling, shop owners could be fined up to $10,000 and may be imprisoned for a period of up to two years, if convicted.

To learn more about the dangers of buying health products from dubious sources, you can visit http://www.healthdangers.sg.

Those with any information on the sale and supply of these capsules or other illegal products can contact HSA’s Enforcement Branch at 68663485 during office hours from Monday to Friday.

mldas@sph.com.sg

– See more at: http://yourhealth.asiaone.com/content/woman-diagnosed-cushings-syndrome-hsa-warns-public-avoid-itch-removing-capsule#sthash.3odVhMMe.dpuf

HSA issues alert on 2 illegal pain relief products

SINGAPORE: The Health Sciences Authority (HSA) on Wednesday (Jun 3) issued an alert on two illegal health products sold in Singapore, one of which caused a consumer to be hospitalised for adverse reactions.

HSA added that investigations are ongoing and laboratory tests have found undeclared potent medicinal ingredients in the products.

A woman in her 40s has been hospitalised for “delirium (confusion), high blood sugar, electrolyte imbalance in her blood and suspected Cushing’s syndrome (characterised by a round face or ‘moon face’ and upper body obesity within thin limbs)” after consuming an illegal pain relief product, said HSA.

The woman had been consuming the “powder packed in unlabelled pink sachets” for pain relief over a prolonged period of time because she believed it had “miraculous powers”, HSA added. The powder was found to contain the illegal ingredients Chlorpheniramine and Dexamethasone.

The patient had bought the powder from “an auntie who sells powdered medicine” – a woman in her 60s who would personally deliver the products to the addresses provided by the customers, said HSA.

HSA raided the peddler’s home and discovered another illegal health product – black pills labelled “special effect rheumatism pill”. They were found to contain Dexamethasone and Chlorpheniramine, as well as Bromhexine.

Dexamethasone could cause diabetes, high blood pressure, cataracts and Cushing’s syndrome, among other adverse reactions. Chlorpheniramine and Bromhexine could cause symptoms including diarrhoea, nausea and vomiting.

The authority advised members of the public who have purchased or are consuming the products to:

Consult a doctor as soon as possible before stopping usage as sudden discontinuation of steroids without proper medical supervision can cause serious withdrawal symptoms

Avoid buying health products from street peddlers, unknown websites or sellers, or even from well-meaning friends or relatives

Be wary of health products not properly labelled with ingredient information or make exaggerated claims like “instant pain relief”

Seek appropriate medical treatment from a doctor for the management of acute and chronic medical conditions such as arthritis and rheumatism

via HSA issues alert on 2 illegal pain relief products – Channel NewsAsia.

Utility of measurement of dexamethasone levels in the diagnostic testing for Cushing’s syndrome

From Day 1 of the 16th International Congress of Endocrinology and the Endocrine Society’s 96th Annual Meeting and Expo »

Chicago, IL – June 21, 2014

ST Sharma, JA Yanovski, SB Abraham, LK Nieman

Summary: Dexamethasone (dex) suppression tests (DST) are used for screening and differential diagnosis of Cushing’s syndrome (CS). The 1 mg overnight (LD) DST is used to diagnose CS, the dex-suppressed CRH stimulation (Dex-CRH) test to differentiate CS from pseudocushings (PCS) while the 8 mg overnight (HD) DST is used to differentiate Cushing’s disease (CD) from ectopic ACTH syndrome (EAS). Researchers assessed the utility of dex levels in improving the diagnostic accuracy of these tests and they found that low dex and high CBG levels can account for false positive (FP) DST and Dex-CRH test results. Use of a higher dex dose in pts with low dex levels can help decrease FP results.

Methods:

  • This is a retrospective study of patients (pts) with CS, PCS and normal volunteers (NV) who had a dex level measured as part of LDDST, HDDST or Dex-CRH test.
  • A post-dex cortisol (F) level ≥1.8 mcg/dl in the LDDST and a 15 min post-CRH F level ≥1.4 mcg/dl in the Dex-CRH test suggested CS.
  • A ≥69% suppression of F levels in HDDST indicated CD.
  • Dex levels

Results:

  • LDDST (n=77): Post-dex F was abnormal in 44 pts, 37 of these did not have CS on follow-up.
  • Proportion of pts with low dex levels was similar in those with incorrect or correct LDDST results (P=0.7).
  • Three of 5 pts with an abnormal result and low dex levels (44-117 ng/dl) had suppressed post-dex F levels after a 2 mg overnight DST. HDDST (N=56): Results were not consistent with the final diagnosis (CD or EAS) in 13 (23%) pts.
  • Of these, 5 had low dex levels (400-1220 ng/dl).
  • Proportion of pts with low dex levels was similar between those with correct and incorrect HDDST results (P=0.5).
  • HDDST in 1 pt with ACTH-dependent CS suggested EAS (28% suppression) with low dex level.
  • IPSS indicated CD.
  • After a doubled dex dose (16 mg), F levels suppressed by 76%, changing the HDDST result to CD.
  • Dex-CRH (n=139): Results were consistent with the final diagnosis in 133 pts (74 CS, 20 NV, 39 PCS).
  • Six pts with an abnormal result had dex levels
  • Of these, repeat testing with doubled dex dose (1 mg every 6 hours) in 2 pts led to higher dex levels (610, 757 ng/dl) and normal F level in one.
  • Two pts with abnormal result were on OCPs, 1 with a known high cortisol binding globulin (CBG) level.
  • None had CS on follow-up.
  • There was no correlation between dex and post-dex F levels in LDDST, 15 min post-CRH F levels in Dex-CRH test and % suppression of F post-dex in HDDST (P=NS).

Suspected case of Cushing’s Syndrome with history of taking medicines prescribed by registered Chinese medicine practitioner

The Department of Health (DH) today (February 18) alerted clients who have consulted a registered Chinese medicine practitioner (CMP) Mr Chan Kong-kin (CMP Chan), practising at G/F, No.25, Leung Tin Village in Tuen Mun, should consult health-care professionals for advice if they have been supplied with medicines suspected to be Western medicines.

The appeal followed the DH’s investigation into two public complaints. The first complaint involved a 23-year-old woman who consulted CMP Chan for management of eczema. She was given a type of green pills, two types of yellow pills and a type of red-yellow capsules for treatment of her disease for about one year.

She developed round face and increased facial hair which are features compatible with Cushing’s syndrome and steroid overdose can cause the syndrome. The patient was admitted to a public hospital on February 5 for investigation and was discharged on February 7.

The second complaint involved a 24-year-old woman who was recommended by the first complainant to consult CMP Chan for management of allergic rhinitis and eczema. She was given similar medicines as those for the first complainant for three days.

Her condition was stable.

Today, chemical analysis by the Government Laboratory on the patients’ drug samples showed that Western medicine Dexamethasone was detected in the red-yellow capsule.

Dexamethasone is a potent steroid. Taking dexamethasone for a long time, especially when in substantial dosage, can cause side effects such as moon face, high blood pressure, high blood sugar, muscle atrophy, peptic ulcer and even osteoporosis.

DH has set up a hotline 2125 1133 for public enquiries related to the medicines prescribed by the CMP.

It will operate from 9am to 9pm, Monday to Friday.

“Preliminary investigation by the DH revealed that pills and capsules were found in the CMP’s premises and all have been seized for further investigation,” the spokesman said.

“In December 31, 2012, the DH announced that CMP Chan was found in possession of Part I poisons and unregistered pharmaceutical products in the same clinic which also involved medicines with steroid. The DH subsequently took enforcement action and the relevant legal proceeding is in progress.

The case has also been referred to the Chinese Medicine Council of Hong Kong for follow-up action,” the spokesman added

“On completion of our investigation, the DH will seek advice from the Department of Justice regarding possible contravention of the Pharmacy and Poisons Ordinance (Cap 138) for the illegal sale or possession of Part I poisons. According to the Ordinance, the maximum penalty for each offence is a fine of $100,000 and two years’ imprisonment. Besides, the DH will also refer this case to the Chinese Medicine Council of Hong Kong for possible disciplinary action”, the spokesman remarked.

People who have been supplied with medicines by the concerned CMP and are in doubt should consult health-care professionals as soon as possible.

They should submit the medicines to the Chinese Medicine Division of DH at 16/F, AIA Kowloon Tower, Landmark East, 100 How Ming Street, Kwun Tong, during office hours for disposal.

Source: HKSAR Government

From http://7thspace.com/headlines/453015/suspected_case_of_cushings_syndrome_with_history_of_taking_medicines_prescribed_by_registered_chinese_medicine_practitioner.html

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