{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T19:02:58Z","timestamp":1774551778815,"version":"3.50.1"},"reference-count":20,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"\n Summary<\/jats:title>\n 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\u2019s 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\u2013pituitary\u2013adrenal (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 this case report, we would like to stress upon the importance of imposition of stringent regulations on social media and websites that disseminate unverified information. Furthermore, we emphasize that incentivizing and promoting health literacy among the general population is an urgent imperative.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Clinicians should be familiar with commonly used herbal remedies and their potential endocrine and systemic effects, particularly in the context of unexplained hormonal dysfunction.<\/jats:p>\n <\/jats:list-item>\n \n Cushingoid features and secondary adrenal insufficiency in the absence of exogenous steroid use should prompt clinicians to enquire specifically about herbal supplement intake, including dose, formulation, and duration.<\/jats:p>\n <\/jats:list-item>\n \n Both clinicians and the public should be aware that excessive doses and prolonged use of ashwagandha can lead to Cushingoid features and sustained suppression of the HPA axis.<\/jats:p>\n <\/jats:list-item>\n \n The widespread belief that \u2018natural\u2019 always equates to \u2018safe\u2019 needs to be actively challenged through public education campaigns and clinician-led counseling. Herbal products can cause deleterious health effects and are not inherently benign.<\/jats:p>\n <\/jats:list-item>\n \n There is a pressing need for health authorities to establish evidence-based guidelines for the safe use of ashwagandha and other commonly used herbal products, including daily dose limits and duration.<\/jats:p>\n <\/jats:list-item>\n \n International regulatory oversight and policies are essential to counter the growing misinformation around traditional and alternative medicines, especially on digital and social media platforms.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-25-0076","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T17:58:14Z","timestamp":1768845494000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["From herbal hope to hormonal havoc: chronic ashwagandha use and HPA axis suppression"],"prefix":"10.1530","volume":"2026","author":[{"given":"Juveria","family":"Javid","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0433-5433","authenticated-orcid":true,"given":"Sumana Reddy","family":"Kunnuru","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatrice","family":"Anne","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sania","family":"Muskan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Nizam\u2019s Institute of Medical Sciences, Hyderabad, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Toxicol Environ Health Sci","first-page":"141","article-title":"Adrenal hypofunction associated with ashwagandha (Withania somnifera) supplementation: a case report","volume":"14","author":"Fry CH","year":"2022","unstructured":"Fry CH\n, \nFluck D\n & \nHan TS\n\n. Adrenal hypofunction associated with ashwagandha (Withania somnifera) supplementation: a case report. Toxicol Environ Health Sci 2022 14 141\u2013145. (https:\/\/doi.org\/10.1007\/s13530-022-00122-z)"},{"key":"bib2","series-title":"Br J Hosp Med","first-page":"1","article-title":"Herbal remedies as a potential cause of hypoadrenalism","volume":"14","author":"Patel M","year":"2024","unstructured":"Patel M\n, \nNewell R\n, \nHillier M\n, et al.\n Herbal remedies as a potential cause of hypoadrenalism. Br J Hosp Med 2024 14 1\u20134. (https:\/\/doi.org\/10.12968\/hmed.2024.0038)"},{"key":"bib3","series-title":"Molecules","first-page":"866","article-title":"Anti-neuroinflammatory effects of adaptogens: a mini-review","volume":"29","author":"Wr\u00f3bel-Biedrawa D","year":"2024","unstructured":"Wr\u00f3bel-Biedrawa D\n & \nPodolak I\n\n. Anti-neuroinflammatory effects of adaptogens: a mini-review. Molecules 2024 29 866. (https:\/\/doi.org\/10.3390\/molecules29040866)"},{"key":"bib4","series-title":"J Psychoact Drugs","first-page":"1","article-title":"Safety and efficacy of ashwagandha root extract on cognition, energy and mood problems in adults: prospective, randomized, placebo-controlled study","author":"Kale S","year":"2024","unstructured":"Kale S\n, \nLopresti A\n, \nSuri R\n, et al.\n Safety and efficacy of ashwagandha root extract on cognition, energy and mood problems in adults: prospective, randomized, placebo-controlled study. J Psychoact Drugs 2024 1\u201313. (https:\/\/doi.org\/10.1080\/02791072.2024.2424279)"},{"key":"bib5","series-title":"Nutrients","first-page":"5015","article-title":"Effects of Withania somnifera on cortisol levels in stressed human subjects: a systematic review","volume":"15","author":"Della Porta M","year":"2023","unstructured":"Della Porta M\n, \nMaier JA\n & \nCazzola R\n\n. Effects of Withania somnifera on cortisol levels in stressed human subjects: a systematic review. Nutrients 2023 15 5015. (https:\/\/doi.org\/10.3390\/nu15245015)"},{"key":"bib6","series-title":"Int J Mol Sci","article-title":"Can ashwagandha benefit the endocrine system? A review","volume":"24","author":"Wici\u0144ski M","year":"2023","unstructured":"Wici\u0144ski M\n, \nFajkiel-Madajczyk A\n, \nKurant Z\n, et al.\n Can ashwagandha benefit the endocrine system? A review. Int J Mol Sci 2023 24 16513. (https:\/\/doi.org\/10.3390\/ijms242216513)"},{"key":"bib7","series-title":"Molecules","first-page":"1208","article-title":"Biodiversity, biochemical profiling, and pharmaco-commercial applications of Withania somnifera: a review","volume":"28","author":"Gaurav H","year":"2023","unstructured":"Gaurav H\n, \nYadav D\n, \nMaurya A\n, et al.\n Biodiversity, biochemical profiling, and pharmaco-commercial applications of Withania somnifera: a review. Molecules 2023 28 1208. 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(https:\/\/doi.org\/10.1097\/md.0000000000017186)"},{"key":"bib10","series-title":"Nutrients","first-page":"1293","article-title":"Effects of Withania somnifera extract in chronically stressed adults: a randomized controlled trial","volume":"16","author":"Pandit S","year":"2024","unstructured":"Pandit S\n, \nSrivastav AK\n, \nSur TK\n, et al.\n Effects of Withania somnifera extract in chronically stressed adults: a randomized controlled trial. Nutrients 2024 16 1293. 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