Critical Care: Student/Resident Case Report Poster - Critical Care I |

“Fountain of Youth”: A Trip to the ICU FREE TO VIEW

Junzhi Lin, MD; Mingwei Sun, PhD; Mingchen Song, MD; Rama Poola, MD
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Southern Illinois School of Medicine, Springfield, IL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):387A. doi:10.1016/j.chest.2016.08.400
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SESSION TITLE: Student/Resident Case Report Poster - Critical Care I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Most patients believe that dietary supplements are safe and not considered medication, and they do not report their use to physicians unless specifically asked. This case reminds physicians that an OTC supplement may be the key piece in a puzzle.

CASE PRESENTATION: A 39-year-old male presented with complaints of nausea, vomiting, diarrhea, and weakness for 9 days. The patient had blood pressure of 76/39 and heart rate of 96/min. Labs showed pancytopenia and acute kidney injury. He was admitted to the ICU for shock and required treatment with vasopressors. Differential diagnosis include GI bleeding and septic shock, but both were ruled out as hemoglobin stayed stable without any signs of bleeding and negative workup for infection. Later, the patient reported that he had lost weight and decreased mass in his biceps and chest. He denied taking steroids, but was taking DHEA, an OTC dietary supplement, for the past 4 years. He stopped taking DHEA 9 days prior. A random cortisol level was low at 1.0mcgs/dL. A Cosyntropin stimulation test confirmed adrenal insufficiency. This case suggests suppression of adrenal axis from chronic DHEA use, with an acute event of gastroenteritis, precipitating adrenal crisis. The patient was treated with stress dose steroids and discharged on maintenance dose and a follow up with Endocrinology.

DISCUSSION: DHEA gained popularity in 1980s during which time the broadcast media touted it as the “Fountain of Youth” that slows the aging process and builds muscle mass1,2. In 1985 the FDA prohibiting over-the-counter sales DHEA. However, the passage of the Dietary Supplement Health and Education Act of 1994 ended that ban. Knowledge of the long-term side effects of DHEA is limited. This case report may shed some light on the adverse side-effects of long-term DHEA use. DHEA could inhibit bone marrow cell and hemocytoblast proliferation in mice3. This suggests that DHEA may have contributed to the patient’s pancytopenia. This case also suggests suppression of adrenal axis from chronic DHEA use. To our knowledge this is first case report revealing adrenal suppression and pancytopenia as effects of chronic DHEA use.

CONCLUSIONS: This case provides insight to the potential side effects of chronic DHEA use, which are largely unknown, and reminds physicians of the danger of OCT dietary supplements such as DHEA. Additionally, it highlights the importance of reexamining the patient history when clinical picture is unclear.

Reference #1: Flynn M, et al: Dehydroepiandrosterone replacement in aging humans. J Clin Endocrinol Metab 1999; 84(5):1527-1533.

Reference #2: Morales AJ, et al: The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol 1998; 49:421-432.

Reference #3: Catalina F, et al: Dietary dehydroepiandrosterone inhibits bone marrow and leukemia cell transplants: role of food restriction. Exp Biol Med 2003; 228:1303-20.

DISCLOSURE: The following authors have nothing to disclose: Junzhi Lin, Mingwei Sun, Mingchen Song, Rama Poola

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