Forensic Post-Mortem Investigation in AAS Abusers: Investigative Diagnostic Protocol. A Systematic Review

Abstract

Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders; AASs are among the most used drugs for improving physical performance, as well as for aesthetic purposes. The use of AASs by professional and recreational athletes is increasing worldwide. This review focused on deaths related to AAS abuse and to investigation of the autopsy results and histopathological findings using a rigorous methodology protocol covering: a complete autopsy, histological analysis, and a broad toxicological investigation. Moreover, we aimed to define an investigative diagnostic protocol supporting forensic pathologists during the post-mortem investigation of AAS abusers. This review was conducted using PubMed Central and Google Scholar databases to find articles published between 1 January 1968 and 30 June 2021, using the following key terms: “(anabolic-androgenic steroids) AND (autopsy); (anabolic-androgenic steroids) AND (forensic)”. A total of 939 articles were screened and 926 did not meet the inclusion criteria. In conclusion, 14 articles were included in this systematic review, reporting 137 fatal cases of AAS abuse in total. The histopathologic studies showed myocardial damage characterized by myocyte hypertrophy, focal myocyte damage with myofibrillar loss, interstitial fibrosis, mostly subepicardial, and small vessel disease. Indeed, in AAS-related cases, autopsy plays a pivotal role in the study of AAS adverse effects and organ damage related to their use or abuse. This systematic review aimed to define a specific workflow in death cases related to AASs, suggesting important future insights to better clarify sudden deaths related to AASs, such as the use of miRNAs. The forensic community needs a unified approach in cases of suspected death related to the use of AASs. There are several occasions to apply this workflow, for example in cases of death of bodybuilders and of young people who die in gymnasiums or during sports activities.

Pharmacogenetics and Forensic Toxicology: A New Step towards a Multidisciplinary Approach

“…In particular, P-gp is a 170 kDa ATP-dependent drug transporter and plays an important role in protecting the brain from potentially harmful substances [74,75]. Interindividual and population differences play a decisive role in the functionality of endogenous toxins, psychotropic drugs, and xenobiotics [76].…”

Smart drugs and neuroenhancement: what do we know?

“…In fact, this systematic review of the literature shows that most people using smart drugs are unaware of potential addiction [11,12,39,40,[44][45][46][47][48][49][50][53][54][55]. In particular, a survey conducted among the teachers of a school included in this review showed that half of the teachers thought that smart drugs are useless and ineffective, while 40% thought smart drugs were addictive.…”

“…In 2015, 6/8% of German university students used smart drugs [10]. Despite the increase in the prevalence of smart drug users, the use of these substances appears to be underestimated [11]. The most frequently used smart drugs and nootropics are caffeine, modafinil, methylphenidate, and amphetamines.…”

“…This aspect plays a crucial role in public health, considering the increase in the use of smart drugs in young and worker populations [13-17, 37, 38]. To date, there are few longitudinal and experimental studies on the effects of smart drugs, certainly also for ethical reasons [8][9][10][11][12]. However, their use is increasing, even if the benefits and side effects of these drugs are not well known.…”

Anabolic–androgenic steroids: How do they work and what are the risks?

“…However, this does not preclude the possibility that these changes might become permanent with more prolonged AAS use or with repeated cycles that provide too little time for recovery to take place in between. This is especially worrisome as there is considerable evidence that myocardial injury, which may accumulate in years of ongoing AAS use, is a primary cause for sudden cardiac death in AAS users (217).…”