J Clin Gastroenterol. 2002 Oct;35(4):350-2.
Androgenic/Anabolic steroid-induced toxic hepatitis.
Stimac D, Milić S, Dintinjana RD, Kovac D, Ristić S.
Division of Gastroenterology, Department of Internal Medicine, Clinical Hospital
Center Rijeka, Rijeka, Croatia. davor.stimac@ri.hinet.hr
Athletes and bodybuilders often misuse androgenic/anabolic steroids. When used in
therapeutic doses, these drugs produce clinical jaundice in just a small number
of recipients. We present a 26-year-old male bodybuilder who self-administered
high doses of androgenic/anabolic steroids that induced liver damage. One month
before admission to the hospital, he used testosterone enanthate (500 mg
intramuscularly, twice weekly), stanozolol (40 mg/d), and methylandrostenediol
(30 mg/d by mouth, for 5 weeks). On admission, his bilirubin level was 470
micromol/L (direct, 360 micromol/L), his aspartate aminotransferase (AST) level
was 5,870 IU/L, his alanine aminotransferase (ALT) level was 10,580 IU/L, his
alkaline phosphatase (ALP) level was 152 IU/L, his gamma-glutamyl-transpeptidase
level was 140 IU/L, his albumin level was 27.6 g/L, and his prothrombin time was
29%. During the patient's prolonged hospitalization, multiple tests and liver
biopsy were performed, showing only toxic hepatic lesions. The patient was
provided with supportive medical treatment. Clinical signs and laboratory
findings improved substantially 12 weeks after the patient discontinued
androgenic/anabolic steroids. The reasons for presenting this case were the much
higher values of AST and ALT levels than reported in other studies, although the
values of bilirubin and ALP were similar to those found in the literature. To our
knowledge, it is the first case of toxic hepatitis induced by androgenic/anabolic
steroids with predominantly hepatocellular necrosis instead of intrahepatic
cholestasis.
