Acute Pancreatitis Secondary to the Use of Anabolic Steroids

Abstract

Background: The use of performance-enhancing drugs has increased dramatically in the last decade with high prevalence reported among the young athlete population. Many of these drugs contain anabolic steroids and may carry potential significant side effects and health risks. We report a case of anabolic steroid-induced acute pancreatitis that recurred after the re-administration of the same drug by the patient, confirming the causative relationship. Case Presentation: A 24 year-old White male presented with severe epigastric pain. His past medical history was significant for two hospitalizations during the last year with acute pancreatitis (AP). On the first episode, the patient labs were significant for elevated serum lipase >3000 units/L. He underwent extensive evaluation that ruled out common causes of acute pancreatitis. On the second AP attack, his repeat imaging scans revealed biliary sludge and he underwent elective cholecystectomy. However, two months later the patient presented to our facility with recurrent severe epigastric pain and the CT scan then confirmed mild AP. His physical exam revealed a well-build masculine male with epigastric tenderness to palpation. Known etiologies of AP were again ruled out, as the work up showed absence of alcohol intake by history and serum levels, normal serum triglycerides and normal pancreas anatomy on abdominal CT, normal ducts and unremarkable endoscopic ultrasound exams. Upon further pressing, patient admitted to history of past and current anabolic steroid use for athletic performance enhancement. He began this use 3 years ago and most recently he started using Trenbolone Acetate, a very powerful anabolic steroid. He stopped taking this drug during hospitalizations but restarted it shortly afterwards and increased the doses till he developed symptoms of AP again. The correlation between the timing of steroids administration and the attacks of AP, along with ruling out other causes, confirmed Trenbolone Acetate as the cause of his pancreatitis. His condition resolved with conservative management and withdrawal of drugs. Discussion: Anabolic steroid use is reported as a rare cause of acute pancreatitis. The side effects associated with the use of these increasingly prevalent drugs are difficult to study in clinical trials due to the unethical nature of their consumption. Physicians need to be aware of any serious consequences with their use.