A Scoping Review of Self-Medication in Exogenous Cushing Syndrome: The Role of Social Determinants of Health in the Case Report Literature

OBJECTIVE: The occurrence of exogenous Cushing syndrome (E-CS) after self-medication with over-the-counter products containing steroids is well documented. However, the potential role of underlying social determinants of health (SDoH) on the practice of self-medication resulting in CS has not been systematically investigated. We aimed to examine the contribution of SDoH on the occurrence of E-CS due to self-treatment in the case report literature.

METHODS: Adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, we performed a scoping review using primary sources published in the form of case reports or case series from 1998-2024. Only reports in English and on adults were included. Information extracted included SDoH, demographics, product and reason for use, and clinical complications.

RESULTS: Thirty-six publications met the inclusion criteria. Seven of 8 reports from the United States involved an over-the-counter product with undisclosed steroid content marketed for joint disease; 19 of 28 international case reports/series involved self-medication with labeled pharmaceutical products. Although complications were consistently identified, SDoH were discussed in only 5 of 36 reports and mentioned in 3. Social factors identified included lack of access to health care, low health literacy, language barriers, and traditional and cultural practices. All reports, except 2, were found in journals with prepublication peer review processes.

CONCLUSION: The presence of SDoH in the case report literature on E-CS due to self-medication is weak. It is necessary to move away from solely disease-focused approaches to those that incorporate SDoH. Peer reviewers and journal editors may help advance change by requesting that case reports/series on self-medication inform on SDoH.