Prolonged Intrahepatic Cholestasis and Renal Failure Secondary to Anabolic Androgenic Steroid-Enriched Dietary Supplements

Krishnan, Prasad; Feng, Zi-Cai; Gordon, Stuart C.

doi:10.1097/mcg.0b013e318188be6d

Cited by 40 publications

(35 citation statements)

References 16 publications

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“…Anabolic steroids are known to be hepatotoxic, but treatment strategies have not been carefully evaluated. Consistent with published reports, anabolic steroids induced DILI is associated with a cholestatic pattern of liver injury [37,38,39]. Rarely, there may be elevated levels of aminotransferases [40,41].…”

Section: Discussionsupporting

confidence: 77%

Steroid and Ursodesoxycholic Acid Combination Therapy in Severe Drug-Induced Liver Injury

et al. 2011

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Background: Drug-induced liver injury (DILI) is the leading cause of acute severe liver disease in Western countries. Treatment strategies for DILI are still not well defined. Aim: We studied the safety and outcomes of steroid/ursodesoxycholic acid (UDCA) combination therapy in DILI patients. Patients, Materials and Methods: 15 consecutive patients with severe DILI were analyzed for clinical, biochemical and histological data. Nine patients were treated with a steroid step-down therapy with reduction of the daily dose over several weeks; 6 patients received a steroid pulse therapy for 3 days. UDCA was administered for several weeks in both groups. Results: Patients without histological signs of preexistent liver damage (n = 10) showed the most favorable clinical course. Bilirubin and serum transaminases dropped to <50% of peak values within 2 weeks, and normalized within 4–8 weeks. In contrast, patients with positive autoimmune antibodies (anti-nuclear antibodies and/or soluble liver antigen) and/or histological features of chronic hepatitis (n = 3) exhibited a slower reduction in bilirubin and serum transaminase levels. These patients were given immunosuppressants (steroids, azathioprine) for a further 6 months. Conclusion: Treatment of severe DILI with corticosteroids (both pulse and step-down therapy) and UDCA appears to be safe, and leads to a more rapid reduction in bilirubin and transaminases after DILI.

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Section: Discussionsupporting

confidence: 77%

Steroid and Ursodesoxycholic Acid Combination Therapy in Severe Drug-Induced Liver Injury

et al. 2011

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“…In contrast, neutrophil and macrophage infiltration into the liver is felt to be a late event in patients with APAP overdose and other drugs that directly injure peri-central hepatocytes (63). Similarly, patients with bland cholestasis due to anabolic steroids may develop liver injury through direct toxicity to bile salt or other drug transporters (64). …”

Section: Inferences Of Dili Pathogenesis From Liver Histologymentioning

confidence: 99%

Pathogenesis of Idiosyncratic Drug-Induced Liver Injury and Clinical Perspectives

2014

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Idiosyncratic drug-induced liver injury (DILI) is a rare disease that develops independently of drug dose, or route or duration, of administration. Furthermore, idiosyncratic DILI is not a single disease entity, but rather a spectrum of rare diseases with varying clinical, histologic, and laboratory features. The pathogenesis of DILI is not fully understood. Standardization of the DILI nomenclature and methods to assess causality, along with the information provided by the LiverTox website, will harmonize and accelerate DILI research. Studies of new serum biomarkers such as glutamate dehydrogenase, high-mobility group box-1 protein, and microRNA-122 could provide information for use in diagnosis and prognosis, and provide important insights into mechanisms of DILI pathogenesis. Single nucleotide polymorphisms in the HLA region have been associated idiosyncratic hepatotoxicity attributed to flucloxacillin, ximelagatran, lapatanib, and amoxicillin- clavulanate. However, genome-wide association studies of pooled cases have not associated any genetic factors with idiosyncratic DILI. Whole-genome and whole-exome sequencing analyses are underway to study DILI cases attributed to a single medication. Serum proteomic, transcriptome, and metabolome, along with intestinal microbiome, analyses will increase our understanding of the mechanisms of this disorder. Further improvements to in vitro and in vivo test systems should advance our understanding of the causes, risk factors, and mechanisms of idiosyncratic DILI.

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“…The risks associated with supplement use are not specific to swimmers, and, indeed, many are not specific to athletes generally. The number of case reports of adverse health effects resulting from supplement use in recent years has been increasing, and many of these have affected recreationally active individuals and amateur athletes, with hepatotoxicity being the most common problem (Food and Drug Administration, 2012;Krishnan et al, 2009;Stickel et al, 2009;Timcheh-Hariri et al, 2012).…”

Section: Potential Harmful Effects Of Supplement Usementioning

confidence: 99%

Dietary Supplements for Aquatic Sports

Derave¹,

Tipton²

2014

International Journal of Sport Nutrition and Exercise Metabolism

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Many athletes use dietary supplements, with use more prevalent among those competing at the highest level. Supplements are often self-prescribed, and their use is likely to be based on an inadequate understanding of the issues at stake. Supplementation with essential micronutrients may be useful when a diagnosed deficiency cannot be promptly and effectively corrected with food-based dietary solutions. When used in high doses, some supplements may do more harm than good: Iron supplementation, for example, is potentially harmful. There is good evidence from laboratory studies and some evidence from field studies to support health or performance benefits from appropriate use of a few supplements. The available evidence from studies of aquatic sports is small and is often contradictory. Evidence from elite performers is almost entirely absent, but some athletes may benefit from informed use of creatine, caffeine, and buffering agents. Poor quality assurance in some parts of the dietary supplements industry raises concerns about the safety of some products. Some do not contain the active ingredients listed on the label, and some contain toxic substances, including prescription drugs, that can cause health problems. Some supplements contain compounds that will cause an athlete to fail a doping test. Supplement quality assurance programs can reduce, but not entirely eliminate, this risk.

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Prolonged Intrahepatic Cholestasis and Renal Failure Secondary to Anabolic Androgenic Steroid-Enriched Dietary Supplements

Cited by 40 publications

References 16 publications

Steroid and Ursodesoxycholic Acid Combination Therapy in Severe Drug-Induced Liver Injury

Steroid and Ursodesoxycholic Acid Combination Therapy in Severe Drug-Induced Liver Injury

Pathogenesis of Idiosyncratic Drug-Induced Liver Injury and Clinical Perspectives

Dietary Supplements for Aquatic Sports

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