Impact of long-term androgenic anabolic steroid use on a critically-ill patient following traumatic injury

Abstract

Introduction: Androgenic-anabolic steroids (AAS) are synthetic derivatives of testosterone often used to enhance athletic performance. While short and long-term complications of AAS are recognised clinically, their impact on management of intensive care unit patients after traumatic injury is poorly defined. Furthermore, the implication for glucocorticoid administration is unclear. Objectives/Aims: Here we describe the use of glucocorticoids for haemodynamic support in a long-term AAS user admitted to the intensive care unit (ICU) after traumatic injury. Methods: A 44-year-old male with history significant for depression and AAS use presented to the emergency department after a motor vehicle accident. Injuries included grade 4 liver laceration, rib fractures 5-7, grade 2 right kidney laceration, open dislocation of the right fourth digit, dilation of ascending aorta with aortic valve stenosis, left ventricular hypertrophy, and comminuted complex tear of left ilium, acetabulum and inferior public ramus. He was transferred to the ICU where his course was complicated by hemodynamic instability, acute renal failure requiring renal replacement therapy (RRT), acute respiratory distress syndrome requiring mechanical ventilation and sepsis. Results: During ICU admission, norepinephrine and vasopressin were prescribed per institution guidelines. Hydrocortisone was added for increased vasopressor requirements and concerns of cortisol depletion with previous AAS use and worsening sepsis. Despite transition to midodrine with RRT, norepinephrine was restarted on hospital day 15 for ongoing adrenal insufficiency. Vasopressin and hydrocortisone were also reinitiated for haemodynamic lability, and hydrocortisone tapered over a 14-day course was required. Conclusion: Long-term users of AAS are at risk for complications during hospitalisation, specifically adrenal insufficiency. Use of a prolonged course of glucocorticoid therapy may be necessary for haemodynamic support in patients requiring vasopressor therapy.