Spectrum of Drug Induced Liver Injury Caused by Anabolic Androgenic Steroids Abuse
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.
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.
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.
KeywordsHerbal Dietary Supplement Bodybuilding Hepatotoxicity Jaundice
Anabolic Androgenic Steroids
Body building supplements
Drug Enforcement Agency
Drug induced liver injury
Drug induced liver injury network
Food and Drug Administration
gamma glutamyl transpeptidase
Herbal and Dietary supplements
National Institutes of Health
Nodular regenerative hyperplasia
Roussel Uclaf Causality Assessment Method
- T Bili
Upper limit of normal
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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