Multiple hepatic adenomas caused by long-term administration of androgenic steroids for aplastic anemia in association with familial adenomatous polyposis

J Gastroenterol. 2000;35(7):557-62.

Multiple hepatic adenomas caused by long-term administration of androgenic
steroids for aplastic anemia in association with familial adenomatous polyposis.

Nakao A, Sakagami K, Nakata Y, Komazawa K, Amimoto T, Nakashima K, Isozaki H,
Takakura N, Tanaka N.

Department of Surgery, Shobara Red Cross Hospital, Japan.

We report a rare case of hepatic adenomas (HA), in a 20-year-old Japanese girl
treated for 6 years with anabolic androgens for aplastic anemia. In a review of
the world literature using computer MEDLINE search, we found only 17 cases of
androgen-induced HA published between 1975 and 1998 in the English-language
literature. The patient was referred to us because of liver lesions detected
during a follow-up examination for familial adenomatous polyposis. After being
diagnosed with aplastic anemia at 14 years of age, she had been treated with
oxymetholone (30 mg/day) for 6 years. Laboratory evaluation revealed normal liver
function. Ultrasonography (US) and computed tomography (CT) demonstrated multiple
liver lesions. Histopathological examinations of biopsied specimens from the
liver tumor showed HA. After the patient was diagnosed with HA, oxymetholone was
tapered off. Patients taking androgenic-anabolic steroids should be carefully
monitored with US and CT and tumor markers should be measured. This report may be
helpful in identifying the population who is at risk of developing hepatic sex
hormone-related tumors.

Use of growth hormone and other anabolic agents in AIDS wasting

JPEN J Parenter Enteral Nutr. 1999 Nov-Dec;23(6 Suppl):S202-9.

Use of growth hormone and other anabolic agents in AIDS wasting.

Mulligan K, Tai VW, Schambelan M.

Division of Endocrinology, San Francisco General Hospital, CA 94110, USA.

Body wasting and loss of lean body mass (LBM) have been associated with increased
mortality and disease progression, and reduced quality of life, in patients with
human immunodeficiency virus (HIV) infection. The failure of nutritional
therapies and, more recently, of effective viral suppression, to consistently
restore LBM has prompted investigation of the pharmacologic use of a number of
specific protein anabolic agents, including recombinant human growth hormone
(rhGH), insulin-like growth factor I (rhIGF-I), and synthetic testosterone
derivatives, such as nandrolone decanoate, oxandrolone, and oxymetholone. In a
placebo-controlled trial, treatment with rhGH resulted in a significant and
sustained increase in weight that was accompanied by an even greater increase in
LBM and a decrease in fat, and improvement in treadmill work output. Preliminary
data suggest that short-term rhGH treatment may be effective in mitigating weight
loss in patients with secondary infections. Open-label studies of nandrolone
decanoate suggest that this injectable agent also can increase weight and LBM.
Two oral agents, oxandrolone and oxymetholone, can increase weight, but their
effects on LBM in placebo-controlled trials have not been reported. Taken
together, these studies demonstrate that HIV-infected individuals can regain
weight and LBM under the proper therapeutic circumstances. The effects of
reversal of wasting on survival and disease progression, long-term safety, and
the potential value of these therapies in the treatment of fat redistribution
remain to be determined.

Oxymetholone: I. Evaluation in a comprehensive battery of genetic toxicology and in vitro transformation assays

Toxicol Pathol. 1999 Sep-Oct;27(5):501-6.

Comment on:
    Toxicol Pathol. 1999 Sep-Oct;27(5):507-12.

Oxymetholone: I. Evaluation in a comprehensive battery of genetic toxicology and
in vitro transformation assays.

Holden HE, Studwell D, Majeska JB.

Department of Toxicology and Safety Assessment, Boehringer Ingelheim
Pharmaceuticals, Ridgefield, Connecticut 06877, USA. heholden@midcoast.com

Oxymetholone is generally assumed to be a nongenotoxic carcinogen. This
assumption is based primarily on the results of an Ames test, existing data in
repeat-dose toxicology studies, and the predicted results of a 2-yr National
Toxicology Program (NTP) rat carcinogenicity bioassay. To provide a comprehensive
assessment of its genotoxicity in a standard battery of mutagenicity assays,
oxymetholone was tested in microbial and mammalian cell gene mutation assays, in
an in vitro cytogenetics assay (human lymphocytes), and in an in vivo
micronucleus assay. Oxymetholone was also tested in an in vitro morphologic
transformation model using Syrian hamster embryo (SHE) cells. These studies were
initiated and completed prior to the disclosure of the results of the NTP
bioassay. Oxymetholone was tested at doses up to 5,000 microg/plate in the
bacterial plate incorporation assay using 4 Salmonella strains and the WP2 uvrA
(pKM101) strain of Escherichia coil. There was no induction of revertants up to
the highest dose levels, which were insoluble as well as toxic. In the L5178Y
tk+/- mouse lymphoma assay, doses up to 30 microg/ml reduced relative survival to
approximately 30% with no increase in mutants. Male or female human lymphocytes
were exposed in vitro to oxymetholone for 24 hr without S9 or 3 hr with S9 and
evaluated for the induction of chromosomal aberrations. There was no increase in
aberration frequency over control levels and no difference between male and
female cells. Peripheral blood from Tg.AC transgenic mice treated dermally for 20
wk with 0, 1.2, 6.0, or 12.0 mg/day of oxymetholone and from p53 transgenic mice
treated orally by gavage for 26 wk with 125, 625, or 1,250 mg/kg/day of
oxymetholone was evaluated for micronuclei in polychromatic and normochromatic
erythrocytes. There was no difference in micronuclei frequency between control
and treated animals. These results confirm that oxymetholone is not genotoxic in
a comprehensive battery of mutagenicity assays. In the SHE assay, oxymetholone
produced a significant increase in morphologically transformed colonies at dose
levels of 13-18 microg/ml. The lack of genotoxicity of oxymetholone, the positive
response in the in vitro transformation assay, and the results of transgenic
mouse carcinogenicity assays will provide an interesting perspective on the
results of an on-going NTP rat carcinogenicity bioassay.

Poststeroid balance disorder--a case report in a body builder

Int J Sports Med. 1999 Aug;20(6):407-9.

Poststeroid balance disorder--a case report in a body builder.

Bochnia M, Medraś M, Pośpiech L, Jaworska M.

Clinic of Otolaryngology, Medical University in Wroclaw, Poland.

The authors describe a case of poststeroid balance disorder in a 20-year-old
athlete. Previous information of such a doping pathology among sportsmen taking
anabolics was not found. That anabolic steroids had a harm to central activities
and could be suspected especially on the basis of reported psychiatric sequels
and cerebrovascular disorders. The case described is of a patient who had been
given metandienone, oxymetholone, and nandrolone phenyloproprionate in two
courses. Vertigo appeared twice just after introducing doping and persisted in
spite of a 1.5 year break in taking anabolics. In the electronystagmography a
positional nystagmus was detected, the eye-tracking test was distempered, and
abnormal responses in the caloric tests were obtained. In the computed dynamic
posturography the number and length of body sway were increased and,
consequently, the field of the outspread area was enlarged. The moment of
appearance and long-lasting vertigo as well as the results of laboratory
examinations indicate a poststeroid permanent disorder of the central part of the
equilibrium organ. Such a diagnosis seems to be most probable here.

Analysis of 65 Turkish patients with congenital aplastic anemia (Fanconi anemia and non-Fanconi anemia): Hacettepe experience

Clin Genet. 1997 May;51(5):296-302.

Analysis of 65 Turkish patients with congenital aplastic anemia (Fanconi anemia
and non-Fanconi anemia): Hacettepe experience.

Altay C, Alikaşifoglu M, Kara A, Tunçbilek E, Ozbek N, Schroeder-Kurth TM.

Department of Pediatrics, Pediatric Hematology Unit, Ihsan Dogramaci Children's
Hospital, Hacettepe University, Ankara, Turkey.

During the last 14 years, 65 unrelated patients were diagnosed as having
constitutional aplastic anemia (CAA). In 52 of 65 patients the diepoxybutane
(DEB) test was positive. Comparison of several hematological and clinical
parameters in Fanconi anemia (FA) (DEB+) and non-Fanconi anemia (non-FA)(DEB )
patients disclosed no statistically significant differences. The study indicated
that in Turkey there were no peculiarities in associated congenital abnormalities
in FA and non-FA. The rate of consanguinity was 78% in FA and 46% in non-FA,
suggesting that also among the non-FA group recessively inherited disorders are
hidden. The mean age at diagnosis in FA was 7.7+/-4.4 (1.8-12) and in non-FA
7.8+/-3.8 (2-15) years. Nine out of 52 FA and five out of 13 non-FA patients died
during the follow-up period. Five of the 52 FA patients developed malignancies,
three of them had acute myeloblastic leukemia (AML), one a squamous cell
carcinoma of the gingiva, and another a hepatocellular carcinoma. Peliosis
hepatica occurred in three of the FA and one of the non-FA patients. A total of
seven patients stayed in remission without any medication. The remaining 58
patients were given 2-5 mg/kg of oxymetholone and 5 mg prednisolone treatment.
Because of sustained remission, oxymetholone therapy was terminated in four of
the 45 FA and two of the 13 non-FA patients. Detailed examination of the
pedigrees of all of patients indicated the presence of multiple congenital
anomalies. In seven of 52 FA and one of 13 non-FA patients there was increased
risk for AML and/or other cancers among family members.

Hepatocellular carcinoma associated with anabolic steroid therapy: report of a case and review of the Japanese literature

J Gastroenterol. 1996 Jun;31(3):450-4.

Hepatocellular carcinoma associated with anabolic steroid therapy: report of a
case and review of the Japanese literature.

Kosaka A, Takahashi H, Yajima Y, Tanaka M, Okamura K, Mizumoto R, Katsuta K.

Department of Surgery, Matsusaka City Hospital, Mie, Japan.

We report herein the case of a 35-year-old woman with aplastic anemia who
developed hepatocellular carcinoma after long-term therapy with oxymetholone. She
was treated with 60 mg/day of oxymetholone for 3 years (total dose 64.8 g).
Alpha-fetoprotein, hepatitis B surface antigen, and hepatitis C antibody were all
negative, but serum titers of carcinoembryonic antigen and carbohydrate antigen
were elevated. Lateral segmentectomy of the liver was performed. The
histopathological findings were compatible with those of multiple hepatocellular
carcinoma without liver cirrhosis. Three years since the operation, the patient
is doing well and no signs of tumor recurrence have been detected. According to
our review of Japanese cases of hepatocellular carcinoma associated with anabolic
steroid therapy, in all instances the tumors developed after long-term
administration of anabolic steroids for hematologic diseases. In patients under
long-term anabolic steroid therapy, routine screening of the liver by
ultrasonography and computed tomography should be performed to detect liver
tumors in the early stages.

Oxymetholone promotes weight gain in patients with advanced human immunodeficiency virus (HIV-1) infection

Br J Nutr. 1996 Jan;75(1):129-38.

Oxymetholone promotes weight gain in patients with advanced human
immunodeficiency virus (HIV-1) infection.

Hengge UR, Baumann M, Maleba R, Brockmeyer NH, Goos M.

Department of Dermatology, University of Essen, Germany.

The effect of the testosterone derivative oxymetholone alone or in combination
with the H1-receptor antagonist ketotifen, which has recently been shown to block
tumour necrosis factor alpha (TNF alpha), on weight gain and performance status
in human immunodeficiency virus (HIV) patients with chronic cachexia was
evaluated in a 30-week prospective pilot study. Thirty patients were randomly
assigned to either oxymetholone monotherapy (n 14) or oxymetholone plus ketotifen
(n 16). Patients receiving treatment were compared with a group of thirty
untreated matched controls, who met the same inclusion criteria. Body weight and
the Karnofsky index, which assesses the ability to perform activities of daily
life, and several quality-of-life variables were measured to evaluate response to
therapy. The average weight gain at peak was 8.2 (SD 6.2) kg (+ 14.5% of body
weight at study entry) in the oxymetholone group (P < 0.001), and 6.1 (SD 4.6) kg
(+10.9%) in the combination group (P < 0.005), compared with an average weight
loss of 1.8 (SD 0.7) kg in the untreated controls. The mean time to peak weight
was 19.6 weeks in the monotherapy group and 20.8 weeks in the combination group.
The Karnofsky index improved equally in both groups from 56% before to 67% after
20 weeks of treatment (P < 0.05). The quality of life variables (activities of
daily life, and appetite/nutrition) improved in 68% (P < 0.05) and 91% (P < 0.01)
of the treated patients respectively. Oxymetholone was safe and promoted weight
gain in cachectic patients with advanced HIV-1 infection. The addition of
ketotifen did not further support weight gain. These results suggest the need for
a randomized, double-blind, placebo-controlled multicentre trial.

Other therapies for wasting

GMHC Treat Issues. 1995 May;9(5):7-8, 12.

Other therapies for wasting.

Smart T.

AIDS: Individuals with wasting syndrome lose muscle or lean body mass rather than
body fat. Several possible alternatives to the approved drugs for AIDS-related
wasting are discussed. Ketotifen, an antihistamine approved in Europe, is a TNF
inhibitor. Anabolic steroids are testosterone derivatives designed to increase
strength and muscle. Although there are anecdotal reports of success with these
steroids, their long-term safety and efficacy have yet to be established in
placebo-controlled studies. An ongoing study at Mt. Sinai shows a statistically
significant effect on lean body mass in the first twelve men to complete the
study. Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal gland.
Although its role in the body is poorly understood; it may have immunologic
effects, and appears to influence metabolism. There have been no studies of
DHEA's effect on weight or body composition in people with AIDS-related wasting.
A study combining ketotifen and oxymetholone, the oral anabolic steroid, was
presented at the Ninth International AIDS Conference. Preliminary data from a
study combining ketotifen and oxymetholone showed that 18 out of 22 patients
gained an average of 11.4 pounds after treatment of an average of 3.9 weeks.
Finally, a trial of smoked marijuana versus the oral drug marinol for
AIDS-related wasting syndrome may be canceled. The Drug Enforcement
Administration (DEA) and the National Institute of Drug Abuse (NIDA) rejected the
Community Consortium of San Francisco's proposal to obtain officially sanctioned
cannabis.

Assessment of attentional bias and mood in users and non-users of anabolic-androgenic steroids

Drug Alcohol Depend. 1995 Mar;37(3):241-5.

Assessment of attentional bias and mood in users and non-users of
anabolic-androgenic steroids.

Bond AJ, Choi PY, Pope HG Jr.

Department of Psychiatry, Institute of Psychiatry, University of London, UK.

Forty-six male strength athletes took part in a study to measure the effects of
anabolic-androgenic steroids on attentional bias to aggressive cues. They were 16
current users of anabolic steroids, 16 former users and 14 non-users.
Testosterone, deca-durabolin and anadrol were the three most commonly taken
steroids during the last cycle. Users generally took 2-3 drugs during each cycle;
the average cycle lasted 8-11 weeks and they had completed 3-4 cycles. The
subjects completed visual analogue scales of current feelings and were presented
with a modified Stroop Colour Word Conflict Task containing sets of neutral,
verbally aggressive and physically aggressive words. Current users tended to rate
themselves more negatively. Users took longer than former users to name the
colours of all word sets but there were no significant differences between word
sets. Therefore, attentional bias did not differ between groups but current
steroid use produced subtle mood changes and slowed performance compared to users
not currently taking steroids.

Rupture of the triceps tendon associated with steroid injections.

Am J Sports Med. 1993 May-Jun;21(3):482-5.

Comment in:
    Am J Sports Med. 1995 Nov-Dec;23(6):778.

Rupture of the triceps tendon associated with steroid injections.

Stannard JP, Bucknell AL.

Orthopaedic Surgery Service, Brook Army Medical Center, Fort Sam Houston, Texas.

Rupture of the triceps mechanism is an uncommon injury that has been recognized
with increasing frequency in recent years. It has been proposed that such
injuries commonly accompany fractures of the radial head and must be actively
evaluated in the presence of such a fracture. We present a unique case of
isolated rupture of the triceps tendon in an athlete who was lifting weights.
This case was complicated by a history of olecranon bursitis that had been
treated with numerous local steroid injections, as well as a history of anabolic
steroid abuse. Both systemic steroids and local injections may predispose tendons
to rupture. Triceps tendon ruptures may result in uniformly good to excellent
results if recognized and treated surgically. This case also serves as a reminder
of the risks of treating inflamed tissues with local steroid injections,
especially in strength athletes who place high demands on their musculoskeletal
structures. Finally, this case documents a second case of triceps mechanism
rupture in an athlete who has abused anabolic steroids. A study by Hunter et al.
suggests that oral steroid abuse may be associated with detrimental effects on
the mechanical properties of connective tissue, demonstrating another negative
effect of anabolic steroid use in athletes.

A familial case of hereditary angioneurotic edema in Japan

Intern Med. 1992 Mar;31(3):353-6.

A familial case of hereditary angioneurotic edema in Japan.

Yamato H, Nakashima Y, Ninomiya K, Sakurai S, Kuroiwa A.

Second Department of Internal Medicine, University of Occupational and
Environmental Health, School of Medicine, Kitakyushu, Japan.

A 53-year-old man was admitted with impairment of breathing following laryngeal
edema. Serum levels of CH50 (22 U/ml), C4 (3 mg/dl), C1-INH protein (10.6 mg/dl)
and C1-INH activity (LT 25%) were low. Complement study of the patient's family
members revealed that he was one of 5 patients in 3 generations with hereditary
angioneurotic edema (HANE). Administration of the androgen derivatives Danazol
(600 mg/day) and Oxymetholone (30 mg/day) effectively increased serum levels of
C1-INH activity and C4. Though eruption and hepatic dysfunction attributable to
administration of the drugs appeared, these side effects improved after
withdrawal of the drugs. Subsequently, the treatment with Danazol at a low dose
(100 mg/day) was resumed, and the patient has had no episodes of edema for the
past 3 years. Regarding the familial cases of HANE, fewer than 20 have been
reported in Japan.

A clinico-haematologic profile of paroxysmal nocturnal haemoglobinuria

J Assoc Physicians India. 1991 Oct;39(10):741-3.

Comment in:
    J Assoc Physicians India. 1991 Oct;39(10):735-6.

A clinico-haematologic profile of paroxysmal nocturnal haemoglobinuria.

Saxena R, Malhotra OP, Saraya AK.

Department of Medicine, All India Institute of Medical Sciences, New Delhi.

Clinico-haematological parameters in sixteen patients of paroxysmal nocturnal
haemoglobinuria (PNH) are presented. Their modes of presentation included
recurrent episodes of cola-coloured urine (6/16), refractory anaemia (9/16) and
predominant thrombotic manifestations (1/16). Laboratory investigations revealed
the presence of anaemia (16/16), reticulocytosis (14/16), thrombocytopenia
(11/16), leucopenia (5/16) and cellular bone marrow (14/16). Two patients had
hypoplastic bone marrow initially but subsequently developed PNH. The patients
were treated with haematinics, prednisolone (16/16) and oxymethalone (2).
Prednisone was effective in suppressing haemolytic episodes. Oxymethalone given
to the 2 patients with hypoplastic bone marrow resulted in amelioration of
anaemia in one but no effect in the other patient.

Hepatocellular carcinoma and squamous cell carcinoma in a patient with Fanconi's anemia

Ann Hematol. 1991 Jul;63(1):54-5.

Hepatocellular carcinoma and squamous cell carcinoma in a patient with Fanconi's
anemia.

Linares M, Pastor E, Gomez A, Grau E.

Department of Hematology, Hospital de Xátiva Lluis Alcanyis, Valencia, Spain.

Acute leukemia, hepatocellular carcinoma, and squamous cell carcinoma have been
reported in patients with Fanconi's anemia. We report on a 31-year-old woman who
developed squamous cell carcinoma of the esophagus and hepatocellular carcinoma.
Jaundice and hepatic tumor developed in 1981, after she had received oxymetholone
for 10 years. Liver biopsy revealed peliosis hepatis. Androgenic therapy was
stopped and the jaundice resolved. However, the hepatic tumor was observed to be
unchanged. The patient died of disseminated squamous cell carcinoma, but no
metastatic lesions from hepatocellular carcinoma were detected in the autopsy.
The association of Fanconi's anemia and squamous cell carcinoma is reviewed, and
the malignant potential of androgen-related hepatic tumors is discussed.

Effect of extended use of single anabolic steroids on urinary steroid excretion and metabolism

J Chromatogr. 1989 Apr 7;489(1):121-6.

Effect of extended use of single anabolic steroids on urinary steroid excretion
and metabolism.

Harrison LM, Martin D, Gotlin RW, Fennessey PV.

Department of Pediatrics, University of Colorado, Denver 80262.

Long-term use of single anabolic steroids by weightlifters and body builders at
dosages greater than or equal to 25 mg per 24 h resulted in reduced excretion of
urinary androgen metabolites, androsterone and etiocholanolone, compared to
values prior to anabolic use. The excretion of major urinary metabolites of
glucocorticoids was not affected by anabolic use. Urinary excretion of anabolic
steroids or anabolic metabolites averaged 20-25% of total anabolic steroid
administered. The major excreted metabolites of methandrostenolone, nandrolone,
oxandrolone and oxymetholone were identified by gas chromatography-mass
spectrometry based on the major mass spectral ion peaks.

Oxymetholone therapy in patients with familial antithrombin III deficiency

Thromb Haemost. 1988 Dec 22;60(3):495-7.

Oxymetholone therapy in patients with familial antithrombin III deficiency.

Shibuya A, Ninomiya H, Nakazawa M, Nagasawa T, Yoda Y, Abe T.

Division of Hematology, University of Tsukuba, Ibaraki, Japan.

Three patients with familial antithrombin III (ATIII) deficiency, who also have
histories of thromboembolism, were treated with oxymetholone in combination with
warfarin. Thrombolysis was observed in one patient with acute thrombosis of
inferior vena cava during the oxymetholone and warfarin therapy. No further
thromboembolic episodes occurred in these patients after initiation of warfarin
with or without oxymetholone. The levels of plasma ATIII, alpha 1-antitrypsin,
plasminogen and Cl-inactivator were significantly increased in all patients after
the introduction of oxymetholone therapy. This suggests that oxymetholone
augments anticoagulant and fibinolytic activity. Hence we consider that
oxymetholone in combination with warfarin may be possible thrombolytic therapy in

Cerebral hemorrhagic infarction associated with anabolic steroid therapy for hypoplastic anemia

Angiology. 1986 Oct;37(10):725-30.

Cerebral hemorrhagic infarction associated with anabolic steroid therapy for
hypoplastic anemia.

Shiozawa Z, Tsunoda S, Noda A, Saito M, Yamada H.

A twenty-two-year-old student with hypoplastic anemia was treated with large
doses of anabolic steroid hormone preparations for two months. Cerebral
hemorrhagic infarction shown by CAT scan developed when his hematologic
conditions were improving. In treating hypoplastic anemia with anabolic steroid
hormone preparations, one should be aware of the possible development of cerebral
hemorrhagic infarction at the time of hematologic improvement.

Long-term survival with tumor regression in androgen-induced liver tumors

Cancer. 1985 Dec 1;56(11):2622-6.

Long-term survival with tumor regression in androgen-induced liver tumors.

McCaughan GW, Bilous MJ, Gallagher ND.

Two patients with androgen-induced liver tumors, one of whom had been partially
treated by a liver resection, are reported. Hepatocellular carcinoma was
diagnosed on histologic grounds. The patients had been receiving androgen therapy
for primary diagnoses of either hypopituitarism or paroxysmal nocturnal
hemoglobinuria. After androgen withdrawal, both are alive and well with no
evidence of residual tumor 10 and 14 years after diagnosis, respectively.

Regression of androgen-related hepatic tumors in patients with Fanconi's anemia following marrow transplantation

Transplantation. 1984 May;37(5):452-5.

Regression of androgen-related hepatic tumors in patients with Fanconi's anemia
following marrow transplantation.

Schmidt E, Deeg HJ, Storb R.

Two patients with Fanconi's anemia treated for 5 years with oxymetholone
developed hepatic function abnormalities in association with hepatic tumors
demonstrated by isotope liver-spleen scan or abdominal echogram. The lesions
resolved over a period of 26 months after allogeneic marrow transplantation, and
the patients are alive and well 3 and 4 years following transplantation. The
course of these patients indicates that marrow transplantation for Fanconi's
anemia allows the withdrawal of androgens and subsequent regression of
androgen-related hepatic tumors in patients who might otherwise have a fatal
outcome.

Hepatic lesions in patients on anabolic androgenic therapy.

Isr J Med Sci. 1983 Apr;19(4):332-7.

Hepatic lesions in patients on anabolic androgenic therapy.

Turani H, Levi J, Zevin D, Kessler E.

The histopathological changes in the livers of 11 patients treated with alkylated
and nonalkylated anabolic androgenic steroids are presented. The histological
changes in the liver included: proliferation of the bile ducts with or without
cystic dilatation (9/11), peliosis (8/11), atypical hyperplasia of liver cells
(2/11), and tumors (3/11). The latter included one case of cholangiocarcinoma,
one of hepatocellular carcinoma, and one of combined cholangiocellular and
hepatocellular carcinoma. The pathological changes in the liver in this series
suggest a possible relationship between anabolic androgenic steroids and bile
duct proliferation and/or cholangiocarcinoma.

Superior sagittal sinus thrombosis associated with androgen therapy for hypoplastic anemia

Ann Neurol. 1982 Dec;12(6):578-80.

Superior sagittal sinus thrombosis associated with androgen therapy for
hypoplastic anemia.

Shiozawa Z, Yamada H, Mabuchi C, Hotta T, Saito M, Sobue I, Huang YP.

Of 27 patients with hypoplastic anemia treated between 1971 and 1974 with male
hormone and protein-assimilating hormone, 3 developed superior sagittal sinus
thrombosis (SSST). The clinical symptoms and signs and angiographic findings of
SST were characteristic enough to allow an early diagnosis. Signs related to SST
were seizures, hemiplegia, facial palsy, stupor, and coma, with the most
important prodrome and consistent subjective complaint being headache. Following
discontinuation of the hormone therapy, neurological signs and symptoms related
to SSST gradually subsided. In all cases, the hematological picture improved with
discontinuation of the hormone therapies. It appears that administration of male
hormone can be associated with the development of SSST. If neurological symptoms
and signs of SSST appear, administration of the hormones should be discontinued.