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Current Hepatology Reports

, Volume 18, Issue 4, pp 417–424 | Cite as

Spectrum of Drug Induced Liver Injury Caused by Anabolic Androgenic Steroids Abuse

  • Varun Takyar
  • Andrew StolzEmail author
Drug-Induced Liver Injury (P Hayashi, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Drug-Induced Liver Injury

Abstract

Purpose of Review

Potent anabolic androgenic steroids (AAS) are often illegally present in commercially available body building supplements (BBS) and may cause drug induced liver injury (DILI) with different phenotypes.

Recent Findings

AAS induced DILI typically presents with a prolonged cholestatic liver injury with pruritus and a typical enzyme pattern of elevated transaminases that rapidly fall as alkaline phosphatase slowly increases. Liver biopsy reveals bland cholestasis that usually does not have chronic sequalae. Pathophysiology is unknown and genetic variants in genes associated with cholestatic syndromes were observed in a minority of patients. Chemical analysis of BBS have identified controlled AAS, which were not documented on the label.

Summary

More frequent use of BBS in males to enhance physical performance is predicted to increase the incidence of cholestatic DILI. The typical presentation of AAS induced liver injury in an at risk populations should prompt careful assessment of BBS exposure.

Keywords

Herbal Dietary Supplement Bodybuilding Hepatotoxicity Jaundice 

Abbreviations

AAS

Anabolic Androgenic Steroids

AKP

Alkaline Phosphatase

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

BBS

Body building supplements

DEA

Drug Enforcement Agency

DILI

Drug induced liver injury

DILIN

Drug induced liver injury network

FDA

Food and Drug Administration

GGT

gamma glutamyl transpeptidase

HDS

Herbal and Dietary supplements

NIH

National Institutes of Health

NRH

Nodular regenerative hyperplasia

RUCAM

Roussel Uclaf Causality Assessment Method

T Bili

Total Bilirubin

ULN

Upper limit of normal

Notes

Compliance with Ethical Standards

Conflict of Interest

Varun Takyar and Andrew Stolz each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastrointestinal and Liver DiseasesKeck School of Medicine of the University of Southern CaliforniaLos AngelesUSA
  2. 2.Keck School of Medicine of USCLos AngelesUSA

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