Poškodenie pečene po užívaní anabolických steroidov za účelom rastu svalovej hmoty – skúsenosti z hepatologického pracoviska

Abstract

Introduction: Anabolic agents are prohibited in professional sports, but their availability makes its use widespread among amateur athletes. Our goal was to report all cases of anabolic-induced liver injury. Patients and methods: We included all inpatients with acute liver injury and previous anabolic use over the last 4 years. We recorded history, demographics, laboratory data and imaging, histology, HPVG (hepatic venous pressure gradient) and the outcome. Results: Fifteen men with a median age of 33.1 years were identified. Common symptoms were dyspepsia (47%), jaundice (100%) and dark urine (26.7%); anabolics were used for a median of 66.5 days (25th–75th percentile, 18.3–113.5), baseline bilirubin level was 19.4-times higher than the upper limit of the normal (13.9–27.1), 1 patient (6.7%) had INR > 1.7. The character of the injury was cytolytic in 3 patients (20%), and cholestatic and mixed in 6 patients (40%). Signifi cant alcohol consumption was reported in 2 cases and 4 (26.7%) patients had hepatic steatosis. Patients consuming alcohol had higher baseline and maximum bilirubin level (367 vs. 731 and 454 vs. 801 μmol/ L, P < 0.05). All 10 patients with liver biopsy demonstrated cholestasis, the interface hepatitis in 5 patients (50%), one had F1 fi brosis. The median HVPG was 5 mmHg (4–6). All patients were treated with sylimarin, ACC and UDCA, two (13.3%) with steroids, three (20%) required MARS. The median time to normalize bilirubin was 99 days (64.3–113.5), no death was observed. Conclusion: Experience with anabolic-induced liver injury shows that they lead to cholestatic injury requiring hospitalization and slow recovery with significant costs. Alcohol consumption and steatosis might have a cumulative eff ect.