Versatility of Anabolic Androgenic Steroid–Induced Hepatotoxicity

• Published in: Journal of clinical and experimental hepatology Vol. 12; no. 1; pp. 216 - 221
• Main Authors: Patil, Vaibhav, Jothimani, Dinesh, Harika, Kavya, Hakeem, Abdul Rahman, Sachan, Deepti, Vij, Mukul, Rela, Mohamed
• Format: Journal Article
• Language: English
• Published: India Elsevier B.V 01.01.2022; Elsevier
• Subjects: anabolic steroids; Case Report; cholestasis; DILI; hepatocellular neoplasm; peliosis hepatis; steatosis; peliosis hepatis; DILI; hepatocellular neoplasm; AST; LDLT; ALP; RUCAM; TACE; TPE; ALT; HCC; SALF; AR; CT; HUMP; AAS; anabolic steroids; cholestasis; GGT; HA; LFT; steatosis; HE; ALT, alanine aminotransferase; TPE, therapeutic plasma exchange; RUCAM, Roussel Uclaf Causality Assessment Method; HE, hepatic encephalopathy; LFT, liver function test; ALP, alkaline phosphatase; CT, computed tomography; AAS, anabolic androgenic steroid; DILI, drug-induced liver injury; SALF, subacute liver failure; HA, hepatocellular adenoma; GGT, gamma-glutamyl transferase; TACE, transarterial chemoembolization; LDLT, living donor liver transplantation; HCC, hepatocellular carcinoma; AST, aspartate aminotransferase; AR, androgen receptor; HUMP, hepatocellular neoplasm of uncertain malignant potential
• ISSN: 0973-6883; 2213-3453
• DOI: 10.1016/j.jceh.2021.03.003

The modified derivatives of testosterone, termed as androgenic steroids are indicated in the management of hypogonadism, visceral obesity and metabolic disorders. Anabolic androgenic steroids (AASs) however are surreptitiously used by athletes and body builders for cosmetic purpose owing to their anabolic effects on muscle mass and strength. The unsurveilled use of AASs subjects these users to various side effects involving multiple systems such as the endocrine, genitourinary, hepatobiliary, central nervous, musculoskeletal and psychosocial system. The liver is a hormone-sensitive organ owing to abundance of androgen receptors and is vulnerable to a wide array of hepatotoxicity ranging from asymptomatic liver enzyme elevation to life-threatening subacute liver failure. The type of drug-induced liver injury (DILI) due to AASs can be hepatocellular injury, cholestasis, fatty liver disease, chronic vascular injury and neoplastic disease. Herein, we report three cases of AAS-related DILI associated with AAS abuse.