Versatility of Anabolic Androgenic Steroid-Induced Hepatotoxicity

Abstract

The modified derivatives of testosterone, termed as androgenic steroids are indicated in the management of hypogonadism, visceral obesity and metabolic disorders. Anabolic androgenic steroids (AASs) however are surreptitiously used by athletes and body builders for cosmetic purpose owing to their anabolic effects on muscle mass and strength. The unsurveilled use of AASs subjects these users to various side effects involving multiple systems such as the endocrine, genitourinary, hepatobiliary, central nervous, musculoskeletal and psychosocial system. The liver is a hormone-sensitive organ owing to abundance of androgen receptors and is vulnerable to a wide array of hepatotoxicity ranging from asymptomatic liver enzyme elevation to life-threatening subacute liver failure. The type of drug-induced liver injury (DILI) due to AASs can be hepatocellular injury, cholestasis, fatty liver disease, chronic vascular injury and neoplastic disease. Herein, we report three cases of AAS-related DILI associated with AAS abuse.

Keywords: AAS, anabolic androgenic steroid; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AR, androgen receptor; AST, aspartate aminotransferase; CT, computed tomography; DILI; DILI, drug-induced liver injury; GGT, gamma-glutamyl transferase; HA, hepatocellular adenoma; HCC, hepatocellular carcinoma; HE, hepatic encephalopathy; HUMP, hepatocellular neoplasm of uncertain malignant potential; LDLT, living donor liver transplantation; LFT, liver function test; RUCAM, Roussel Uclaf Causality Assessment Method; SALF, subacute liver failure; TACE, transarterial chemoembolization; TPE, therapeutic plasma exchange; anabolic steroids; cholestasis; hepatocellular neoplasm; peliosis hepatis; steatosis.

Figure 1

(A) Bright-field microscopy displaying liver biopsy with cholestasis (case 1; H&E). (B) Bilirubin trend and correlation with plasma exchange depicted in the line diagram. (C) Bright-field microscopy displaying liver tumour with prominent pseudoacinar transformation (case 2; H&E). (D) Bright-field microscopy displaying peliosis hepatis (case 2; H&E). H&E = haematoxylin and eosin.