Sensi, HBuch, HFord, LGama, R2020-08-282020-08-282019-02-19Sensi H, Buch H, Ford L, et al (2019) Acute adrenal failure: a potentially fatal consequence of an adulterated herbal remedyBMJ Case Reports CP 2019;12:bcr-2018-228443.1757-790X30787026 (pubmed)10.1136/bcr-2018-228443http://hdl.handle.net/2436/623537This is an accepted manuscript of an article published by BMJ in BMJ Case Reports on 19/02/2019, available online: http://dx.doi.org/10.1136/bcr-2018-228443 The accepted version of the publication may differ from the final published version.© 2019 BMJ Publishing Group Limited. Herbal remedies adulterated with glucocorticoids can cause Cushing's syndrome. We report a severe presentation of a 'herbal remedy' adulterated with glucocorticoids; causing a potentially fatal adrenal crisis precipitated by acute illness. Investigations were consistent with adrenal suppression and confirmed, after tablet analysis, to be due to a 'herbal remedy' containing synthetic betamethasone/dexamethasone. This case highlights the need for clinical vigilance and patient education about the potential risks associated with the use of unlicensed treatments and the role of tablet analysis in routine biochemistry.application/pdfenHPA suppressionherbal remediesadulteratedglucocorticoidsCushings syndromeHumansAdrenal InsufficiencyAcute DiseaseHydrocortisoneAnti-Inflammatory AgentsTreatment OutcomePhytotherapyAftercareDrug ContaminationMiddle AgedIntensive Care UnitsPakistanFemaleJournal article1757-790XBMJ Case Reports2020-08-24