title: Steroids in traditional Chinese medicine: what is the evidence?
abstract: Local healthcare providers often question the possible steroidal activity of traditional Chinese medicine (TCM) herbs or herbal products and implicate them as a cause for adrenal insufficiency or Cushing's syndrome in patients with a history of TCM intake. We conducted a comprehensive database search for evidence of potential glucocorticoid, mineralocorticoid, androgenic or oestrogenic activity of herbs or herbal products. Overall, there are not many herbs whose steroidal activity is well established; among these, most cases were based on preclinical studies. Liquorice root may cause pseudoaldosteronism through interference with the steroidogenesis pathway. Although ginseng and cordyceps have some in vitro glucocorticoid activities, the corroborating clinical data is lacking. Deer musk and deer antler contain androgenic steroids, while epimedium has oestrogenic activity. On the other hand, adulteration of herbal products with exogenous glucocorticoids is a recurrent problem encountered locally in illegal products masquerading as TCM. Healthcare providers should stay vigilant and report any suspicion to the relevant authorities for further investigations.
authors.affiliation: Traditional Medicine Information Service, Department of Pharmacy, Singapore General Hospital, Singapore.
authors.forename: Foon Yin
authors.initials: FY
authors.lastname: Fung
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore.
authors.forename: Yeh Ching
authors.initials: YC
authors.lastname: Linn
mesh_terms: D000728:Androgens / Q000032:analysis; D000818:Animals; D032661:Cordyceps; D016208:Databases, Factual; D003670:Deer; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000032:analysis*; D034181:Epimedium; D004967:Estrogens / Q000032:analysis; D005229:Fatty Acids, Monounsaturated; D005938:Glucocorticoids / Q000032:analysis; D029882:Glycyrrhiza uralensis; D006801:Humans; D008516:Medicine, Chinese Traditional / Q000009:adverse effects*; D008901:Mineralocorticoids / Q000032:analysis; D005894:Panax; D028321:Plant Preparations / Q000032:analysis; D012306:Risk; D012846:Singapore; D013256:Steroids / Q000009:adverse effects / Q000032:analysis*; D014020:Tissue Extracts
chemical_list: D000728:Androgens; D004365:Drugs, Chinese Herbal; D004967:Estrogens; D005229:Fatty Acids, Monounsaturated; D005938:Glucocorticoids; D008901:Mineralocorticoids; D028321:Plant Preparations; D013256:Steroids; D014020:Tissue Extracts; C000621428:lu rong; C008563:musk
keywords: adulteration; androgen; corticosteroids; oestrogen; traditional Chinese medicine