From herbal hope to hormonal havoc: chronic ashwagandha use and HPA axis suppression
Abstract
SUMMARY: This case report describes a 55-year-old postmenopausal woman who presented with Cushingoid features and progressive weight gain over a year. Evaluation revealed low basal cortisol levels and a suboptimal response to the ACTH stimulation test, indicative of adrenal insufficiency. Further investigation into her medication regimen uncovered her consistent use of approximately 950 mg of ashwagandha daily for over a year, prescribed by a local practitioner for symptomatic relief of bilateral knee osteoarthritis. A review of the existing literature suggested a potential cortisol-suppressing effect of ashwagandha, leading to the establishment of a causal link between the patient's symptoms and her consumption of the ashwagandha extract. She was advised to discontinue the alternative medication and commenced on hydrocortisone replacement, adjusted for her body surface area. A three-month follow-up indicated that her hypothalamic-pituitary-adrenal (HPA) axis suppression had not yet reversed, necessitating continued hydrocortisone supplementation and bimonthly monitoring of her basal and stimulated cortisol levels. This case report underscores the perils of unsupervised exposure to poorly understood compounds prevalent among the general public. It also highlights the role of online platforms and social media in promoting unverified practices and treatments with spurious claims of efficacy and safety, often in contrast to well-researched, modern treatment regimens. Through…
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