Gray-Market Peptides, Grave Consequences: Saddle Pulmonary Embolism and Diabetic Ketoacidosis from Unsupervised Retatrutide, AOD-9604, and Tesamorelin
https://doi.org/10.15605/jafes.041.S1
- Author:
Wan Zulhafizaini Bin Wan Jusoh
1
;
Md Syazwan Bin Md Amin
2
Author Information
1. Department of Internal Medicine, Hospital Sultan Aziz Shah, Universiti Putra Malaysia (UPM)
2. Endocrine Unit, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
AOD 9604;
tesamorelin;
Diabetic Ketoacidosis;
Pulmonary Embolism;
Peptides
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):62-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:The growing popularity of glucagon-like peptide-1
receptor agonists (GLP-1 RAs) for weight management
has inadvertently perpetuated demand for unregulated
experimental peptides procured through gray markets.
Retatrutide, a novel triple GLP-1/glucose-dependent
insulinotropic polypeptide (GIP)/glucagon receptor agonist
undergoing Phase III trials; AOD -9604, an abandoned
synthetic human growth hormone fragment; and
tesamorelin, a synthetic GHRH analogue, are increasingly
self-administered without medical supervision. Their
combined metabolic and thromboembolic risks remain
unknown and unreported.
Case:A 50-year-old Malaysian female with morbid obesity and
poorly controlled type 2 diabetes mellitus (hemoglobin
A1c 13%) presented with acute dyspnea, chest tightness,
syncope, and cardiogenic shock. Three weeks prior, she
had self-initiated subcutaneous retatrutide, AOD-9604, and
tesamorelin procured through unregulated online platforms,
achieving rapid weight loss of 10 kg. Despite markedly
reduced oral intake from GLP-1-mediated gastrointestinal
side effects, she continued her prescribed high-dose
insulin regimen and sodium-glucose cotransporter-2
(SGLT2) inhibitor without dose adjustment. She developed
concurrent diabetic ketoacidosis, confirmed biochemically,
alongside massive saddle pulmonary embolism with right
ventricular strain on echocardiography and computed
tomography pulmonary angiography. She was successfully
treated with systemic thrombolysis using alteplase,
guideline-directed diabetic ketoacidosis management
including fixed-rate insulin infusion and fluid resuscitation,
and anticoagulation. The SGLT2 inhibitor was withheld
throughout admission. She was discharged on rivaroxaban
with counseling to cease all unregulated compounds. All
three agents were submitted to the National Pharmaceutical
Regulatory Authority/Malaysian Adverse Drug Reactions
Advisory Committee for adverse drug reaction reporting.
Conclusion:To our knowledge, this is the first reported case of
concurrent massive pulmonary embolism and diabetic
ketoacidosis precipitated by unsupervised gray-market
retatrutide, AOD-9604, and tesamorelin. Clinicians should
enquire about unregistered supplement use, counsel
insulin-dependent patients on sick-day rules when appetitesuppressing agents are initiated, and report adverse events
to pharmacovigilance authorities.
- Full text:2026080316221678368EP_A078.pdf
