Trenbolone Acetate Use Causing Acute Hepatitis

Abstract

Purpose: Athletes continuously seek ways to improve performance in their sport and can be drawn to the use of anabolic steroids in order to obtain this goal. They tend to ignore the potentially life-threatening side effects of these drugs and consequently put their overall physical well-being at risk. We describe a case of an amateur body builder who took trenbolone acetate and subsequently developed acute hepatitis. Case: A 40-year-old male amateur bodybuilder took trenbolone acetate by injection for one year and developed jaundice. He had a seven-week history of generalized fatigue, diarrhea with light colored stools, dark urine, and right upper quadrant pain. He denied alcohol use or family history of liver disease. Physical examination showed scleral icterus with a palpable liver 3 centimeters below the costal margin. Laboratory results were significant for Aspartate aminotransferase of 121 IU/L, alanine aminotransferase of 199 IU/L, total bilirubin of 17.4 mg/dL, direct bilirubin of 9.9 mg/dL, albumin of 2.8 mg/dL, total cholesterol of 508 mg/dL, LDL of 389 mg/dL, and HDL of 10 mg/dL. Coagulation profile was normal. Ultrasonography showed a contracted gallbladder with thickened walls and no evidence of intra- or extra-hepatic ductal dilatation. Liver biopsy showed moderately severe parenchymal and canalicular cholestasis with minimal portal inflammation consistent with drug-induced cholestatic hepatitis. Discussion: Hepatic complications associated with anabolic steroid use include hepatocellular and intrahepatic cholestasis. Aminotransferases are usually less than 100 IU\L and serum alkaline phosphatase levels may be mildly elevated. HDL can be decreased and LDL can be increased, which can put these patients at risk for cardiovascular disease. Hepatocellular adenomas and peliosis hepatis have been described. Most of these effects can be reversed upon cessation of the steroids; however there have been fatalities. By methylating testosterone, it undergoes less first pass hepatic metabolism and it's oral bioavailability improves. Trenbolone acetate is a steroid approved for use in veterinary practice as a means of maintaining cattle weight in the days prior to slaughter. It is not approved, nor studied in humans, and its hepatic side effect profile is unknown. Our case reminds health care professionals about the abuse potential of anabolic steroids and the systemic side effects they can cause.