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Derek Huang, Robert Millay, Brian Y Kim; Central serous chorioretinopathy associated with homeopathic adrenal medication. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1929.
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Central serous chorioretinopathy (CSC) has been well described with its association with stress, steroid use and hypercotisolism. However, we present a case of its association with a homeopathic adrenal medication, ADHS. When this medication was discontinued, the patient’s CSC also resolved.
Central serous chorioretinopathy is characterized by leakage of fluid into the subretinal space from the choroid that can lead to serous retinal detachments. CSC is most prevalent in males aged 20-50 years old. Its association with type A personality, stress, steroid use and hypercortisolism has been reported. The prognosis is generally good with spontaneous resolution in weeks to months; however about 5% of patients fail to regain greater than 20/30 acuity.
This is the first case report describing central serous chorioretinopathy in association with the use of homeopathic adrenal medication. A 42 year old man presented with acute visual complaints characterized as “blurry, dark spot in his central vision” in his left eye of two days duration. He acknowledged using 2 tablets of ADHS supplement for adrenal health. ADHS is a homeopathic adrenal support supplement, marketed to support desired dehydroepiandrosterone (DHEA), Secretory IgA and normal cortisol levels. Examination revealed best-corrected visual acuity was 20/20 in the right eye (OD) and 20/30-2 in the left eye (OS). Slit lamp examination showed left retinal pigment epithelial mottling and subretinal fluid. Angiographic examination revealed two areas of leakage in the left eye. OCT was consistent with a diagnosis of central serous chorioretinopathy. During a follow up examination (1 week later), he denied further use of his homeopathic medication and experienced improvement in the dark central spot. His visual acuity was 20/20 OD and 20/30+2 OS. OCT demonstrated improvement in his subretinal fluid.
CSC has been linked to endogenous Cushing’s syndrome, sympathomimetic use ,as well as elevated catecholamine levels. ADHS supplies raw materials necessary for the synthesis of steroid hormones and epinephrine, the conversion of tyrosine to catecholamines, and hormonal secretion. The ingredients and amino acids contained in ADHS could play a role in its pathogenesis in CSC. Additional investigation into the mechanism of adrenal supplementation would aid in establishing guidelines for their use and potential side effects.
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