Steroid-induced cardiomyopathyVisit for more related articles at Anabolic steroids dilated cardiomyopathy of General Practice. Home Publications Conferences Register Contact. Journal of General Practice. Case Report Open Bulking steroid cycle. J Gen Pract 2: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Anabolic steroid use as the possible precipitant of dilated cardiomyopathy. - PubMed - NCBI
In December , a year-old man was admitted via the emergency department of our tertiary hospital with atrial fibrillation AF , new-onset biventricular cardiac failure, acute renal failure and elevated liver function test results. An electrocardiogram confirmed AF with a rapid ventricular response, and he was subsequently admitted to hospital. He had distended jugular veins and cardiac examination revealed a gallop rhythm and an apical pansystolic murmur. His lungs were clear to auscultation and he had no peripheral oedema.
The patient was a successful bodybuilder and strongman. Over the past 12 months, he had taken testosterone 1. The products were obtained through other users at the gym where the patient trained.
He was kg at the time of presentation. Further questioning elicited that he had taken anabolic steroids for about 7 years leading up to his presentation. Further examination did not reveal any evidence of gynaecomastia, testicular atrophy or acne. His social history was otherwise unremarkable. There was no history of heavy alcohol use, smoking or illicit drugs. There was no family history of cardiomyopathy. There were no signs and symptoms of a viral illness.
Fifteen months before presentation, he had a transthoracic echocardiogram for hypertension, which revealed normal biventricular size and systolic function, normal biatrial size, normal diastolic function and normal valve function.
There was no evidence of inducible ischaemia. However, his albumin and bilirubin levels and international normalised ratio were normal. Initial therapy included metoprolol and anticoagulation with low molecular weight heparin. The patient underwent transoesophageal echocardiography on Day 3 of his admission. This showed severe global biventricular dysfunction, moderate to severe mitral regurgitation as a result of annular dilatation, biatrial enlargement, and the presence of spontaneous echo contrast in the left atrial appendage without thrombus.
Electrical cardioversion was performed, resulting in sinus tachycardia; however, AF recurred within 24 hours. Our patient was given carvedilol and ramipril. Low-dose dobutamine infusion was started and continued for 72 hours, resulting in excellent diuresis and improvement in his clinical condition with recovery of liver and kidney function. Investigations to exclude a secondary cause of cardiomyopathy included thyroid function tests, iron studies and plasma metanephrine tests, which all returned normal results.
He had serial transthoracic echocardiograms, with improvement documented in left ventricular structure and function Box. Our patient was treated for a dilated cardiomyopathy as a result of anabolic steroid use. He has now stopped taking anabolic steroids for 18 months.
He weighs kg; however, through a different training regimen, he can lift the same weight as he did when he was kg. Previous work has shown that the use of supraphysiological testosterone doses results in increased fat-free mass, muscle size and strength in men. Of note also is the regimen of anabolic steroid use in our patient.
The amount of testosterone used was about 15—20 times that used for testosterone replacement therapy, and methandrostenolone is not recommended owing to its potential for hepatotoxicity.
Our case highlights an interesting presentation of a dilated cardiomyopathy with acute decompensated heart failure 6 weeks after cessation of anabolic steroids in a patient who had performed physically at an elite level only 2 weeks before admission.
Definitive management involved cessation of the offending agents, exclusion of other reversible causes of heart failure, and initiation of conventional heart failure therapy. Awareness of the harmful cardiac effects of anabolic steroid use must be promoted within the medical profession and among potential users so that such cases can be prevented. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion.
You will be notified by email within five working days should your response be accepted. Basic Search Advanced search search. Use the Advanced search for more specific terms. Case reports Lessons from practice. Volume Issue 5. Med J Aust ; 5: Clinical record In December , a year-old man was admitted via the emergency department of our tertiary hospital with atrial fibrillation AF , new-onset biventricular cardiac failure, acute renal failure and elevated liver function test results.
Lessons from practice Anabolic steroid use and misuse is an important issue in the bodybuilding community. Anabolic steroid use and misuse is an important potential cause of dilated cardiomyopathy. The mainstay of treatment involves abstinence from the offending agent, as well as initiation of conventional heart failure therapy. The effects of supratherapeutic doses of testosterone on muscle size and strength in normal men.
N Engl J Med ; Med J Aust ; Am J Med ; Ahlgrim C, Guglin M. Anabolics and cardiomyopathy in a bodybuilder: J Cardiac Fail ; Testosterone therapy in men with androgen deficiency syndromes: J Clin Endocrinol Metab ; Indirect androgen doping by oestrogen blockade in sports. Br J Pharmacol ; Pharmacology of anabolic steroids. Do you have any competing interests to declare? Email me when people comment on this article.
Hui-Chen Han and colleagues highlight the growing problem of anabolic steroid induced disorders. As endocrinologists we are seeing patients experiencing anabolic steroid-induced hypogonadism ASIH much more commonly 1. The case clearly reinforces the importance of endocrinologists and cardiologists working collaboratively to choose agents so as not to induce gynaecomastia, manage amiodarone induced thyroiditis as well as discuss the use of human chorionic gonadotrophin hCG and selective oestrogen receptor modulators SERMs such as tamoxifen rather than testosterone so as to preserve fertility.
Whilst there is little robust evidence on the effectiveness of all these agents in this group of patients and responsiveness is highly variable, many pitfalls can be avoided by a joint approach which may also involve a community-based addiction team.
Reference 1 Karavolos, M. Male central hypogonadism secondary to exogenous androgens: Clin Endo ; 82 5: Responses are now closed for this article.