Severe intrahepatic cholestasis and liver failure after stanozolol usage – and review of the literature

Stępień, Piotr; Reczko, Katarzyna; Wieczorek, Anna; Zarębska-Michaluk, Dorota; Pabjan, Paweł; Król, Teodora; Kryczka, Wiesław

doi:10.5114/ceh.2015.51376

Cited by 14 publications

(11 citation statements)

References 15 publications

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“…[9][10][11][12][13][14][15][16][17][18] Seventeen patients received antipruritic therapy, predominantly antihistamines and rifampicin, colestyramine, naltrexone and phenobarbital. Twelve patients received UDCA alone, 3 received corticosteroids alone (Abeles RDA) 19 20 and 12 received corticosteroids and UDCA (3 due to 'failure' of UDCA (Abeles RDA)), 19 21 6 patients received MARS 9 16 22 and 1 received plasmapheresis. 23…”

Section: Resultsmentioning

confidence: 99%

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Abeles

Foxton²,

Khan

et al. 2020

BMJ Open Gastroenterol

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BackgroundAnabolic androgenic steroids (AAS) usage is widespread and increasing. AAS drug-induced liver injury (DILI) is recognised but its clinical course and management is poorly described. We report 2 cases of AAS DILI with associated renal dysfunction, managed successfully with oral corticosteroids.MethodsA comprehensive review identified 50 further cases to characterise the clinical and biochemical course. Causality grading was calculated using the updated Roussel Uclaf Causality Assessment Method (RUCAM) score. Data are presented as median values.ResultsThe most common AAS taken was methyldrostanolone. Patients commonly present with jaundice and pruritus but may exhibit other constitutional symptoms. Patients presented 56 days after starting, and bilirubin peaked 28 days after stopping, AAS. Causality assessment was ‘unlikely’ in 1 (2%), ‘possible’ in 31 (60%) and ‘probable’ in 20 (38%). Peak values were: bilirubin 705 μmol/L, alanine transaminase 125 U/L, aspartate transaminase 71 U/L, alkaline phosphatase 262 U/L, gamma-glutamyl transferase 52 U/L, international normalised ratio 1.1. Liver biopsies showed ‘bland’ canalicular cholestasis. 43% of patients developed kidney injury (peak creatinine 225 μmol/L). Therapies included antipruritics, ursodeoxycholic acid and corticosteroids. No patients died or required liver transplantation.ConclusionsPhysicians are likely to encounter AAS DILI. Causality assessment using the updated RUCAM should be performed but defining indications and proving efficacy for therapies remains challenging.

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Section: Resultsmentioning

confidence: 99%

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Abeles

Foxton²,

Khan

et al. 2020

BMJ Open Gastroenterol

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“…Liver was enormously enlargedChemoembolization was declined by patient who was recommended for transplantation [118]AustraliaCRHepatocellular carcinomaSurgery [119]LebanonCRLiver injury resulting in prolonged cholestasis and acute kidney injuryAdvice to discontinue AAS, medical therapy, plasma exchange. Patient refused renal biopsy. [120]ChinaCRDilated cardiomyopathy and acute hepatic injuryMedical therapy [121]PolandCRSevere intrahepatic cholestasis that developed to severe liver failureMedical therapy [122]UKCSCholestasisMedical therapy [123]SpainCRSevere cholestatic jaundiceUnclear [124]USACSSevere hepatotoxicity, cholestasisMedical therapy [125]NetherlandsCRMild jaundice; cholestatic hepatitis identified through liver biopsyMedical therapy [126]UKCRThree grade II oesophageal varicesBlood transfusion and sclerotherapy [127]AustraliaCRIntrahepatic cholestasisMedical therapy [128]USACRSevere cholestasis and renal failure. Re-admitted with pruritusMedical therapy [129]SpainCRHepatic rupture, liver failure.…”

Section: Resultsmentioning

confidence: 99%

Treatments for people who use anabolic androgenic steroids: a scoping review

et al. 2019

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Background: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems.Methods: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible. Results: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided.Conclusion: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health-or drug-related journals, will support development of the evidence base.

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“…La particularidad del presente caso es que el patrón de hepatotoxicidad colestásico persistió en el tiempo, a diferencia de los casos reportados en la literatura, y no hubo falla hepática [9][10][11][12] .…”

Section: Caso Clínicounclassified

“…Los clínicos deben saber que hay instrumentos para establecer la causalidad en casos como este, la escala CIOMSRUCAM es uno de los más conocidos 15,16 . En la Tabla 2 se describen los autores, años y principales características de los reportes sobre estanozolol y alteraciones hepáticas 10,[17][18][19][20][21][22] .…”

Section: Caso Clínicounclassified

Estanozolol como anabólico: una causa de hepatotoxicidad

Ramírez¹,

Mejía

2021

medupb

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Los antibióticos y analgésicos han sido descritos frecuentemente como las principales causas de toxicidad hepática. Los esteroides anabólicos se han relacionado también con alteraciones en sistemas como el cardiovascular o el hepático; en este último causan colestasis, carcinoma hepatocelular, hiperplasia regenerativa nodular y sangrado de varices, secundario a hipertensión portal. Es importante entonces considerar los esteroides anabólicos como factores de riesgo para hepatotoxicidad. Se presenta el primer caso en Colombia y uno de los pocos en Latinoamérica, de colestasis asociada únicamente al uso de estanozolol. Se trata de un paciente de 21 años, en tratamiento con el medicamento para incrementar la masa muscular, que presentó compromiso hepático de tipo colestásico. Se descartaron otras posibles causas de ictericia, mediante la escala CIOMS/RUCAM se llegó a establecer causalidad entre el consumo de estanozolol y la colestasis. El objetivo de este reporte es hacer una descripción no reportada en la literatura colombiana y poco común en la literatura mundial.

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Severe intrahepatic cholestasis and liver failure after stanozolol usage – and review of the literature

Cited by 14 publications

References 15 publications

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Treatments for people who use anabolic androgenic steroids: a scoping review

Estanozolol como anabólico: una causa de hepatotoxicidad

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