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

Abstract

The occurrence of exogenous Cushing's 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. Using primary sources published in the form of case reports or case series from 1998- 2024, and adhering to PRISMA-ScR guidelines, we performed a scoping review to investigate the contribution of SDoH on the occurrence of CS due to self-medication. Information on SDoH, patient demographics, product and reason for use, and clinical complications was extracted. Only reports in English and on adults were included. Thirty-six reports met inclusion criteria. Seven of eight reports from the United States involved an over-the-counter product with undisclosed steroid content marketed for joint disease; 19 of the 28 international case reports/series involved self-medication with labeled pharmaceutical products. Although complications were consistently identified, only five of 36 reports on E-CS due to self-medication discussed and three provided information on SDoH. Social factors identified included lack of access to healthcare, low health literacy, language barriers, and traditional and cultural practices. All reports, except two, were found in journals with pre-publication peer review processes. Our findings point to the weak presence of SDoH in the case report literature on E-CS due to self-medication. 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.