Síndrome de Cushing exógeno de difícil diagnóstico / Exogenous Cushings syndrome with a difficult diagnosis

Resumen Introducción: el síndrome de Cushing (SC) es un grupo de signos y síntomas causados por la exposición crónica al exceso de glucocorticoides. El uso de fármacos con glucocorticoides es la causa más frecuente, pero algunos productos vendidos como suplementos nutricionales o medicamentos naturistas para el control de los dolores articulares pueden contenerlos de forma oculta, lo cual dificulta el enfoque diagnóstico Presentación del caso: paciente de 40 años con signos clínico típicos de síndrome de Cushing con resultados discordantes en las pruebas diagnósticas para identificar su origen. Finalmente se logra establecer que el paciente consumía de forma crónica un producto "naturista" conocido como artrin®, el cual fue analizado en el laboratorio de la institución con resultados positivos para cortisol. Conclusión: la exposición crónica a glucocorticoides exógenos, ya sea subrepticia, desconocida o prescrita, causa SC y debe distinguirse tempranamente de las formas endógenas para evitar la realización de pruebas diagnósticas y tratamientos inadecuados.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1500).

Abstract Introduction: Cushing's syndrome (CS) is a group of signs and symptoms caused by chronic exposure to excessive glucocorticoids. The use of medications containing glucocorticoids is the most common cause, but they may be hidden in some products sold as nutritional supplements or naturopathic medications, which makes the diagnostic approach more difficult. Case presentation: this was a 40-year-old patient with typical clinical signs of Cushing's syndrome and discordant results of diagnostic tests to identify its origin. It was ultimately determined that the patient had been chronically taking a "naturopathic" product known as artrin®, which was analyzed in the institution's lab and found to contain cortisol. Conclusion: chronic exposure to exogenous glucocorticoids, whether surreptitious, unknown or prescribed, causes CS and should be promptly distinguished from endogenous forms to avoid inappropriate diagnostic tests and treatments.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1500).

Identification And Quantification Of Phosphodiesterase-5 Inhibitors As Adulterants In Dietary Supplements Marked For Sexual Enhancement In The Lebanese Market

Objective: Ultraviolet Visible spectrophotometric was adopted to identify and quantify any adulteration with PDE-5 inhibitors (Sildenafil and Tadalafil) in selected dietary supplements used for sexual enhancement in the Lebanese market Methods: Nine dietary supplements, randomly collected from Lebanese pharmacies, were screened for Sildenafil and Tadalafil using UV-spectrophotometry for both qualitative and quantitative detection. Results: Tadalafil was detected in one sample at a dose of 59 mg/dosage unit, with the maximal recommended dose being 20 mg. Sildenafil was detected in five samples at doses ranging from 11.7 to 188.2 mg/dosage unit, with the maximal recommended dose being 100 mg. Conclusion: This study demonstrates that regular analysis of supposed dietary supplements is needed for more effective quality control and health promotion. The method described for the extraction, identification and quantification of Tadalafil and Sildenafil would be useful for regulatory detection of adulterations.

Evaluation of acute and sub-chronic toxicities of Vensestin Cleansers: a polyherbal supplement in female Wistar Albino rats.

The acute and sub-chronic toxicities of Venestin Cleansers® (VC)-a polyherbal supplement in female Wistar Albino Rats Was Evaluated. Acute toxicity of VC in rats was determined. Twenty four weight-matched animals divided into 3 groups of eight rats each were given feed and water only (control), feed + water + 500 mg/kg and feed + water + 1000 mg/kg VC for 28-days. Feed and fluid intakes were measured daily and body weight was taken weekly. Blood was collected by cardiac puncture and necropsy was done after 28 days. Liver and ovary were harvested and histopathological analysis was done. Liver and renal functions tests were carried out. Administration of 2000 mg/kg of VC showed no mortality in the rats after 14 days. Fluid , feed intakes and body weight were increased by 500 and 1000mg/kg VC. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase activities increased significantly (p≤0.05) after VC administration. There was significant (p≤0.05) increase in conjugated bilirubin and total protein levels following administration of 500 and 1000mg/kg VC. Liver histology of the 500 and 1000 mg/kg of VC treated groups showed widespread ballooning, degeneration of the hepatocytes, periportal infiltration by chronic inflammatory cells with loss of radial arrangement of hepatocytes around the central veins. Histological examination of the ovaries showed areas of luteinized stromal cells, normal follicles, normal fallopian tubes. Chronic exposure of VC may have public health importance in man.