The man’s family told doctors that, up until a few months prior, he had been taking three different types of herbal supplements that claim to treat joint pain. The man had taken the supplements for four years, and sometimes as often as four times a day, but he had stopped using them in the lead-up to his illness.

Deadly doses
The supplements were: Artri King, Nhan Sam Tuyet Lien, and Linsen Double Caulis Plus. All are known to contain unlisted glucocorticoids, according to the Food and Drug Administration. And testing of two of the man’s supplements by the hospital confirmed the presence of the steroids.

Doctors determined that the man had essentially overdosed on the glucocorticoids—he had taken doses that exceeded the normal levels of glucocorticoids in the body. The steroids likely suppressed immune responses, leading to his infections and GI ulcers. But, more significantly, the excess steroid levels also caused his HPA axis to essentially shut down. While it’s possible to get the HPA axis back up and running after withdrawal from excessive steroid use, the amount of time that takes can vary. Further, if a person stops taking large doses of glucocorticoids abruptly, rather than gradually—as in the man’s case—and particularly after chronic use—also as in the man’s case—it can lead to an adrenal crisis. In retrospect, the man had all the signs of a crisis.