Resident Physician UTMB Galveston, Texas, United States
Objective : The practice of self-medication is growing in the United States with users taking over-the-counter (OTC) medications or herbal therapies without being aware of their risks. Lack of health insurance and low health literacy disproportionately affect minority populations who may resort to self-medication. These underserved populations are likely more vulnerable to conditions such as Cushing’s syndrome (CS) and secondary adrenal insufficiency after OTC steroid use. However, there is little information on the association of social determinants of health (SDH) and the occurrence ofCS due to self-treatment.
Methods: We performed a scoping review using PRISMA-SCr guidelines to investigate published knowledge over the past 25 years on the association of SDH and the occurrence of CS due to self-medication. Articles were identified in PubMed using the following Title/Abstract search terms: “Cushing”and any of: “Iatrogenic”, “Exogenous”, “Over the Counter”, or “Self Medication”.Non-English articles were excluded. A manual review was performed by a single reviewer and verified by a secondary reviewer to select eligible publications. Articles were excluded if steroid was prescribed, involved factitious useorwas self-administered for reasons other than self-treatment. Endogenous CSand cases in patients younger than 18years old were also excluded. Data obtained from articles included product, duration, country, patient age, clinical outcomes and complications, as well as education level, language barriers, and healthcare access.
Results: From initial 519 screened articles, 20 articles met eligibility criteria for review. Products leading to CS due to self-medication were advertised to patients as “herbal” or “natural” and had undisclosed steroid content. Instances of OTC steroid use in other countries were also documented, demonstrating how ease of steroid access can lead to their use without regular health provider guidance. Severe complications fromself-treatment with steroids were reported in all cases, but underlying SDH were not addressed in all cases and only briefly mentioned in 2reports.
Discussion/Conclusion: The literature clearly identifies the life-threatening consequences of self-medication with steroids. P</span>hysicians should remember to obtain a complete medication history and encourage disclosure of non-prescription medication use from patients presenting with CS. However, our findingshighlight the need for medical journals to recommend that authors assess and describeSDH when reporting complications associated with OTC medication in CS. Medical journals play a major role in raising awareness of the health disparities underlying OTCsteroid use.
