[OA] Anabolic Steroid Abuse: What Shall It Profit a Man to Gain Muscle and Suffer the Loss of His Brain?
The use of anabolic androgenic steroids may be an underestimated cause of cerebral venous thrombosis. The pervasive yet clandestine use of these and other endocrine modulating drugs amongst athletes challenges the epidemiological study of their pro-thrombotic consequences and by extension the astuteness of the clinician in such a circumstance as depicted in this case.
A 30 year-old previously well bodybuilder presented with a 3-day history of increasingly frequent focal motor seizures of his left upper limb and subtle dyscognitive changes ranging from 10 to 30 s duration. Soon after admission, he developed dysarthria and a left sided hemiparesis with greater weakness in the upper limb.
There was no history of headaches or visual changes and his medical, surgical and family history were unremarkable. There was no history of smoking but drug history revealed the consistent use of cycles of anabolic androgenic steroids (AAS) for the preceding 2 years.
The cycles involved parenteral testosterone enanthate 500 mg combined with nandrolone decanoate 400 mg weekly for 3 months. This was alternated with a post-cycle regimen of daily clomiphene citrate 100 mg and tamoxifen citrate 40 mg as well as weekly tapering doses of beta-human chorionic gonadotropin (hCG) 5000 IU for almost 2 months before resuming androgens.
Physical examination exhibited a 90 kg man of athletic build with mild dysarthria and a dense, flaccid left sided hemiparesis including the face. Otherwise, there were no abnormalities.
Laboratory investigations showed a haemoglobin of 18.0 g/dl and a haematocrit of 52.9% with no morphological abnormalities on the blood film. Screening tests for connective tissue and hypercoaguable disorders (including erythrocyte sedimentation rate, anti-neutrophilic antibodies, factor V Leiden, protein C, protein S and lupus anticoagulant) were negative. Renal and liver function tests were also within normal limits but JAK2 mutation testing was not obtained due to financial constraints.
Magnetic resonance imaging with venography of the brain revealed acute superior sagittal sinus thrombosis with an associated cortical based acute infarct in the right parietal lobe. No haemorrhagic conversion was noted at that time.
The patient was treated with sodium valproate to control seizures and low molecular weight heparin was used as a prelude to initiating anticoagulation with warfarin. The pivotal factor in further management was counselling against future use of performance enhancement drugs.
Over the ensuing 6 months of follow-up, with strict compliance to management, there was marked improvement in power and the haematocrit decreased to 45%. Additionally, he has remained seizure free allowing the discontinuation of the anticoagulation and anti-epileptic drugs. Fortunately, there appears to be no residual adverse effects.
Omar M, Abdul R, Panday A, Teelucksingh S. Anabolic steroid abuse: what shall it profit a man to gain muscle and suffer the loss of his brain? QJM. Anabolic steroid abuse: what shall it profit a man to gain muscle and suffer the loss of his brain? | QJM: An International Journal of Medicine | Oxford Academic
The use of anabolic androgenic steroids may be an underestimated cause of cerebral venous thrombosis. The pervasive yet clandestine use of these and other endocrine modulating drugs amongst athletes challenges the epidemiological study of their pro-thrombotic consequences and by extension the astuteness of the clinician in such a circumstance as depicted in this case.
A 30 year-old previously well bodybuilder presented with a 3-day history of increasingly frequent focal motor seizures of his left upper limb and subtle dyscognitive changes ranging from 10 to 30 s duration. Soon after admission, he developed dysarthria and a left sided hemiparesis with greater weakness in the upper limb.
There was no history of headaches or visual changes and his medical, surgical and family history were unremarkable. There was no history of smoking but drug history revealed the consistent use of cycles of anabolic androgenic steroids (AAS) for the preceding 2 years.
The cycles involved parenteral testosterone enanthate 500 mg combined with nandrolone decanoate 400 mg weekly for 3 months. This was alternated with a post-cycle regimen of daily clomiphene citrate 100 mg and tamoxifen citrate 40 mg as well as weekly tapering doses of beta-human chorionic gonadotropin (hCG) 5000 IU for almost 2 months before resuming androgens.
Physical examination exhibited a 90 kg man of athletic build with mild dysarthria and a dense, flaccid left sided hemiparesis including the face. Otherwise, there were no abnormalities.
Laboratory investigations showed a haemoglobin of 18.0 g/dl and a haematocrit of 52.9% with no morphological abnormalities on the blood film. Screening tests for connective tissue and hypercoaguable disorders (including erythrocyte sedimentation rate, anti-neutrophilic antibodies, factor V Leiden, protein C, protein S and lupus anticoagulant) were negative. Renal and liver function tests were also within normal limits but JAK2 mutation testing was not obtained due to financial constraints.
Magnetic resonance imaging with venography of the brain revealed acute superior sagittal sinus thrombosis with an associated cortical based acute infarct in the right parietal lobe. No haemorrhagic conversion was noted at that time.
The patient was treated with sodium valproate to control seizures and low molecular weight heparin was used as a prelude to initiating anticoagulation with warfarin. The pivotal factor in further management was counselling against future use of performance enhancement drugs.
Over the ensuing 6 months of follow-up, with strict compliance to management, there was marked improvement in power and the haematocrit decreased to 45%. Additionally, he has remained seizure free allowing the discontinuation of the anticoagulation and anti-epileptic drugs. Fortunately, there appears to be no residual adverse effects.
Omar M, Abdul R, Panday A, Teelucksingh S. Anabolic steroid abuse: what shall it profit a man to gain muscle and suffer the loss of his brain? QJM. Anabolic steroid abuse: what shall it profit a man to gain muscle and suffer the loss of his brain? | QJM: An International Journal of Medicine | Oxford Academic
