Liver injury after the use of anabolic steroids to promote muscle growth – single-center experience

Česká verzia

Authors: P. Molčan ¹ ; T. Koller ²; N. Bystrianska ¹; J. Strachan ¹; D. Janceková ¹; J. Vnenčáková ¹; P. Vrbová ²; P. Strenáčik ¹; L. Skladaný ¹
Authors place of work: HEGITO – hepatologické, gastroenterologické a transplantačné oddelenie, II. interná klinika SZU a FNsP F. D. Roosevelta Banská Bystrica ¹; Gastroenterologické a hepatologické oddelenie, V. interná klinika LF UK a UN Bratislava-Ružinov ²
Published in the journal: Gastroent Hepatol 2021; 75(2): 118-124
Category:
doi: https://doi.org/10.48095/ccgh2021118

Summary

Introduction: Anabolic agents are prohibited in professional sports, but their availability makes its use widespread among amateur athletes. Our goal was to report all cases of anabolic-induced liver injury. Patients and methods: We included all inpatients with acute liver injury and previous anabolic use over the last 4 years. We recorded history, demographics, laboratory data and imaging, histology, HPVG (hepatic venous pressure gradient) and the outcome. Results: Fifteen men with a median age of 33.1 years were identified. Common symptoms were dyspepsia (47%), jaundice (100%) and dark urine (26.7%); anabolics were used for a median of 66.5 days (25^th–75^th percentile, 18.3–113.5), baseline bilirubin level was 19.4-times higher than the upper limit of the normal (13.9–27.1), 1 patient (6.7%) had INR > 1.7. The character of the injury was cytolytic in 3 patients (20%), and cholestatic and mixed in 6 patients (40%). Significant alcohol consumption was reported in 2 cases and 4 (26.7%) patients had hepatic steatosis. Patients consuming alcohol had higher baseline and maximum bilirubin level (367 vs. 731 and 454 vs. 801 μmol/ L, P < 0.05). All 10 patients with liver biopsy demonstrated cholestasis, the interface hepatitis in 5 patients (50%), one had F1 fibrosis. The median HVPG was 5 mmHg (4–6). All patients were treated with sylimarin, ACC and UDCA, two (13.3%) with steroids, three (20%) required MARS. The median time to normalize bilirubin was 99 days (64.3–113.5), no death was observed. Conclusion: Experience with anabolic-induced liver injury shows that they lead to cholestatic injury requiring hospitalization and slow recovery with significant costs. Alcohol consumption and steatosis might have a cumulative effect.

Conflict of Interest: The authors declare that the article/ manuscript complies with ethical standards, patient anonymity has been respected, and they state that they have no
fi nancial, advisory or other commercial interests in relation to the subject matter.
Publication Ethics: This article/ manuscript has not been published or is currently being submitted for another review. The authors agree to publish their name and e-mail in
the published article/ manuscript.
Dedication: The article/ manuscript is not supported by a grant nor has it been created with the support of any company.
The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for bio medical papers.

Keywords:

drug-induced liver injury – anabolics – Prognosis – Steatosis

Zdroje

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