Anabolic steroid misuse is an important reversible cause of cardiomyopathy: a case report

Abstract

Background Anabolic steroid misuse is very common and has been linked to the development of a severe cardiomyopathy, arrhythmias and sudden death. Case Summary A forty-six year old miner presented to hospital with subacute dyspnoea and palpitations. Investigations revealed atrial fibrillation and a severe dilated cardiomyopathy with left ventricular ejection fraction of 12%. The patient had a history of longstanding exogenous testosterone administration. Haematological investigations demonstrated a marked polycythaemia, with haematocrit of 0.60 L/L (normal 0.40-0.54 L/L). Hormonal investigations revealed an elevated testosterone level of 46.4 nmol/L (normal 8.0–30.0 nmol/L) and suppressed luteinizing and follicle-stimulating hormones, consistent with excess testosterone use. The patient was referred to the endocrinology specialty team for support with ceasing excess testosterone use, while commencing guideline-directed heart failure therapy. At six months’ follow-up, the patient’s left ventricular ejection fraction had normalised and he was asymptomatic. Biochemical indicators of testosterone excess had also normalised. Discussion Anabolic steroids are widely misused, particularly amongst young and middle-aged males. Cardiovascular complications include a potentially reversible severe cardiomyopathy, accelerated coronary disease, dyslipidaemia, arrhythmias and sudden death. It is important to identify a history of anabolic steroid misuse when investigating cardiomyopathy and be alert for indicators such as polycythaemia. Cessation of anabolic steroid missuse may lead to complete reversal of cardiomyopathy but should be undertaken in close partnership with the patient and endocrinologists.

Toxic Cardiomyopathies: Alcohol, Amphetamines, and Anabolic Steroids

“…41,42,45,46 Figure 6 displays a summary of the effects of anabolic steroids on the cardiovascular system. 47…”