<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0120-2448</journal-id>
<journal-title><![CDATA[Acta Medica Colombiana]]></journal-title>
<abbrev-journal-title><![CDATA[Acta Med Colomb]]></abbrev-journal-title>
<issn>0120-2448</issn>
<publisher>
<publisher-name><![CDATA[Asociacion Colombiana de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-24482020000300075</article-id>
<article-id pub-id-type="doi">10.36104/amc.2020.1500</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Exogenous Cushing's syndrome with a difficult diagnosis]]></article-title>
<article-title xml:lang="es"><![CDATA[Síndrome de Cushing exógeno de difícil diagnóstico]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fierro-Maya]]></surname>
<given-names><![CDATA[Luis Felipe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Clavijo]]></surname>
<given-names><![CDATA[Angélica María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Álvarez-Lozano]]></surname>
<given-names><![CDATA[Miguel Ángel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moreno-Soler]]></surname>
<given-names><![CDATA[Gonzalo Alejandro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez-Paz]]></surname>
<given-names><![CDATA[Sebastián]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tarquino-Rincón]]></surname>
<given-names><![CDATA[Daniela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Cancerología  ]]></institution>
<addr-line><![CDATA[Bogotá, D.C ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Nacional de Colombia Unidad de Endocrinología Oncológica ]]></institution>
<addr-line><![CDATA[Bogotá, D.C ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Nacional de Colombia Facultad de Medicina Departamento de Ciencias Fisiológicas]]></institution>
<addr-line><![CDATA[Bogotá, D.C ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2020</year>
</pub-date>
<volume>45</volume>
<numero>3</numero>
<fpage>75</fpage>
<lpage>77</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-24482020000300075&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-24482020000300075&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-24482020000300075&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Cushing's syndrome (CS) is a group of signs and symptoms caused by chronic exposure to excessive glucocorticoids. The use of medications containing glucocorticoids is the most common cause, but they may be hidden in some products sold as nutritional supplements or naturopathic medications, which makes the diagnostic approach more difficult.  Case presentation: this was a 40-year-old patient with typical clinical signs of Cushing's syndrome and discordant results of diagnostic tests to identify its origin. It was ultimately determined that the patient had been chronically taking a "naturopathic" product known as artrin®, which was analyzed in the institution's lab and found to contain cortisol.  Conclusion: chronic exposure to exogenous glucocorticoids, whether surreptitious, unknown or prescribed, causes CS and should be promptly distinguished from endogenous forms to avoid inappropriate diagnostic tests and treatments.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1500).]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: el síndrome de Cushing (SC) es un grupo de signos y síntomas causados por la exposición crónica al exceso de glucocorticoides. El uso de fármacos con glucocorticoides es la causa más frecuente, pero algunos productos vendidos como suplementos nutricionales o medicamentos naturistas para el control de los dolores articulares pueden contenerlos de forma oculta, lo cual dificulta el enfoque diagnóstico  Presentación del caso: paciente de 40 años con signos clínico típicos de síndrome de Cushing con resultados discordantes en las pruebas diagnósticas para identificar su origen. Finalmente se logra establecer que el paciente consumía de forma crónica un producto "naturista" conocido como artrin®, el cual fue analizado en el laboratorio de la institución con resultados positivos para cortisol.  Conclusión: la exposición crónica a glucocorticoides exógenos, ya sea subrepticia, desconocida o prescrita, causa SC y debe distinguirse tempranamente de las formas endógenas para evitar la realización de pruebas diagnósticas y tratamientos inadecuados.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1500).]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[syndrome]]></kwd>
<kwd lng="en"><![CDATA[exogenous glucocorticoids]]></kwd>
<kwd lng="en"><![CDATA[herbal supplements]]></kwd>
<kwd lng="es"><![CDATA[de Cushing]]></kwd>
<kwd lng="es"><![CDATA[glucocorticoides exógenos]]></kwd>
<kwd lng="es"><![CDATA[suplementos herboles]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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