Anabolic Steroid Abuse: Difference between revisions
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== Diagnostic Tests/Lab Tests/Lab Values == | == Diagnostic Tests/Lab Tests/Lab Values == | ||
A urinalysis is the most common screening method with the use of GC-MS, known as gas chromatography and mass spectrometry, which identifies a specific substance in a certain provided sample. Traditionally, gas chromatography (GC) coupled with mass spectrometry (MS) has been used for confirmation of anabolic steroids and their metabolites in human urine.<br><br> | A urinalysis is the most common screening method with the use of GC-MS, known as gas chromatography and mass spectrometry, which identifies a specific substance in a certain provided sample. Traditionally, gas chromatography (GC) coupled with mass spectrometry (MS) has been used for confirmation of anabolic steroids and their metabolites in human urine.<ref name="Jeon">Jeon B, Yoo H, Jeong E, Kim H, Jin C, Kim D, Lee J. LC-ESI/MS/MS method for rapid screening and confirmation of 44 exogenous anabolic steroids in human urine. Springer-Verlag, Anal Bioanal Chem 2011;401:1353–1363.</ref><ref name="Pozo">Pozo O, Eenoo P, Deventer K, Delbeke F. Development and validation of a qualitative screening method for the detection of exogenous anabolic steroids in urine by liquid chromatography-tandem mass spectrometry. Springer-Verlag, Anal Bioanal Chem 2007;389:1209–1224.</ref><br><br> | ||
== Etiology/Causes == | == Etiology/Causes == | ||
Revision as of 00:10, 25 March 2014
Original Editors - Adam Fischer & Nancy Marshall from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Nancy Marshall, Adam Fischer, Wanda van Niekerk, Elaine Lonnemann, 127.0.0.1, WikiSysop, Wendy Walker, George Prudden and Lucinda hampton
Definition/Description[edit | edit source]
Anabolic-androgenic steroids, commonly called “anabolic steroids”, are synthetic substances that resemble male sex hormones (e.g., testosterone). Anabolic steroids promote the growth of skeletal muscle and cause increased production of red blood cells (anabolic effects), and the development of male characteristics (androgenic effects) in both males and females.[1][2] Anabolic steroids are also responsible for muscle and bone cell proliferation, while androgenic is responsible for both primary and secondary sex characteristics. Further benefits of anabolic steroids is the anti-catobolic properties, preventing tissue breakdown commonly assosciated with greater and greater intensity activities (i.e. greater distances, weights, times, etc.).[3]
Common medical uses of anabolic steroids include replacement therapy to treat delayed puberty in adolescent boys, hypogonadism and impotence in men, breast cancer in women, anemia, osteoporosis, weight loss and other conditions with hormonal imbalance.[2]
Anabolic steroids can be injected, taken orally, or applied externally as a gel or cream. Due to the possibility of serious adverse effects and a high potential for abuse, they are classified as Schedule III Controlled Substances in the U.S.[4] Doses taken by abusers can be 10 to 100 times higher than doses used for medical conditions.[1]
Some commonly abused anabolic steroids are listed in the table below.[1]
Prevalence[edit | edit source]
Prevalence of anabolic steroid use is poorly researched, particularly in longevity. Individuals using AAS range from adolescent weight trainers to high level professional athletes and olympians. Most research data collected is acquired through direct survey methods. Due to the nature of self reporting surveys, AAS is likely to be underreported. As social attitude towards the acceptance of anabolic androgenic steroid use changes better profiling of this patient population may be seen.
The 2005 Monitoring the Future study, a NIDA-funded survey of drug use among adolescents in middle and high schools across the United States, reported that past year use of steroids decreased among 8th- and 10th-graders since peak use in 2000. Among 12th-graders, there was a differ- ent trend—from 2000 to 2004, past year steroid use increased, but in 2005 there was a signifi- cant decrease, from 2.5 percent to 1.5 percent.[1]
The prevalence rate for males, 6.4% (95% CI, 5.3–7.7, I2 = 99.2, P < .001), was significantly higher (Qbet = 100.1, P < .001) than the rate for females, 1.6% (95% CI, 1.3–1.9, I2 = 96.8, P < .001). Sample type (athletes), assessment method (interviews only and interviews and questionnaires), sampling method, and male sample percentage were significant predictors of AAS use prevalence. There was no indication of publication bias.[5]
Characteristics/Clinical Presentation[edit | edit source]
Clinical signs and symptoms of anabolic steroid use include:
• Chest pain[6]
• Elevated blood pressure[6][7]
• Ventricular tachycardia [6]
• Altered ejection fraction (lower end of normal: under 55%)[7]
• Rapid weight gain (10-15 pounds in 2-3 weeks)[6][7]
• Peripheral edema[6][7]
• Acne on face, upper back, chest[6][7]
• Altered body composition with marked development of the upper torso[6]
• Muscular hypertrophy[7]
• Stretch marks around the back, upper arms, and chest[6][7]
• Needle marks in large muscle groups (e.g., buttocks, thighs, deltoids)[6][7]
• Development of male pattern baldness[6]
• Gynecomastia (breast tissue development in males); breast tissue atrophy in females[6]
• Frequent hematoma or bruising[6]
• Personality changes called “steroid psychosis” (rapid mood swings, sudden increased aggressive or even violent tendencies)[6][7]
• Females: Secondary male characteristics (deeper voice, breast atrophy, abnormal facial and body hair); menstrual irregularities[6]
• Abdominal pain, diarrhea[7]
• Bladder irritation, urinary frequency, urinary tract infections[7]
• Sleep apnea, insomnia[7]
• Jaundice (chronic use)[6]
Severe depression leading to suicide can occur with anabolic steroid withdrawal.[6]
In the pediatric population, there is a risk of decreased of delayed bone growth. Tendon or muscle strains are common and take longer than normal to heal.[6]
Associated Co-morbidities[edit | edit source]
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Medications
[edit | edit source]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
A urinalysis is the most common screening method with the use of GC-MS, known as gas chromatography and mass spectrometry, which identifies a specific substance in a certain provided sample. Traditionally, gas chromatography (GC) coupled with mass spectrometry (MS) has been used for confirmation of anabolic steroids and their metabolites in human urine.[8][9]
Etiology/Causes[edit | edit source]
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Systemic Involvement
[edit | edit source]
Systemic involvement resulting from anabolic-androgenic steroid abuse varies amongst individuals related to length of use and dosage. Sytems involved include, but are not limited to; endocrine, urogenital, integumentary, cardiovascular, hepatic, skeletal muscle, psychological, pulmonary
Medical Management (current best evidence)[edit | edit source]
Pharmacological management of androgenic anaboloic steroid abuse is not always indicated, with supportive behavioral psychotherapy and patient education of withdrawal signs and symptoms being sufficient plan of care. Psychopharmacological intervention may include prescription anti anxiety or anti depressants in combination with cognitive behavioral therapy. Pharmacological management of AAS abuse addresses hormonal imbalances as a result of chronic use or addressees specific signs and symptoms of withdrawal including; weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain[10]
Physical Therapy Management (current best evidence)[edit | edit source]
Very little information is available providing suggested physical therapy management of the AAS patient. Proffesional healthcare providers are faced with ethical considerations when treating those using or recovering from anabolic-androgenic steroid use and assosciated conditions. The American Medical Assosciation called for a formal ban on over the counter anabolic steroids and assosciated hormonal derivatives.[11]
Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis
[edit | edit source]
Any young adult with chest pain of unknown cause, possibly accompanied by dyspnea and elevated blood pressure and without clinical evidence of neuromusculoskeletal involvement, may have a history of anabolic steroid use. Consider anabolic steroid use as a possibility in men and women presenting with chest pain in their early 20s who have used this type of steroid since age 11 or 12.[6]
Case Reports/ Case Studies[edit | edit source]
Rhabdomyolysis of the Deltoid Muscle in a Bodybuilder Using Anabolic-Androgenic Steroids: A Case Report. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629047/
Delayed diagnosis of a cerebrovascular accident associated with anabolic steroid use. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128333/
Multi-organ damage induced by anabolic steroid supplements: a case report and literature review. http://www.jmedicalcasereports.com/content/2/1/340
add links to case studies here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
• Are Steroids Worth The Risk? http://kidshealth.org/teen/food_fitness/sports/steroids.html
• Mind Over Matter: Anabolic Steroids. http://teens.drugabuse.gov/educators/curricula-and-lesson-plans/mind-over-matter/anabolic-steroids
• National Institute on Drug Abuse: The Science of Drug Abuse & Addiction. http://www.drugabuse.gov/drugs-abuse/steroids-anabolic
• Performance-enhancing drugs: Know the risks. http://www.mayoclinic.org/performance-enhancing-drugs/ART-20046134?p=1
• Gay Teen Boys More Likely to Use Muscle-Building Steroids: Survey: MedlinePlus. http://www.nlm.nih.gov/medlineplus/news/fullstory_144381.html
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Recent Related Research (from Pubmed)
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References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 1.2 1.3 National Institute on Drug Abuse. Anabolic Steroid Abuse. http://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse (accessed 11 Mar 2014).
- ↑ 2.0 2.1 Drugs.com. Androgens and anabolic steroids. http://www.drugs.com/drug-class/androgens-and-anabolic-steroids.html (accessed 22 Mar 2014). Cite error: Invalid
<ref>tag; name "Drugs.com. Androgens and anabolic steroids." defined multiple times with different content - ↑ Fahey TD. Anabolic-androgenic steroids: mechanism of action and effects on performance. Encyclopedia of Sports Medicine and Science 1998. http://www.sportsci.org/encyc/anabster/anabster.html (accessed 23 Mar 2014).
- ↑ Drugs.com. Anabolic Steroids- Abuse, Side Effects and Safety. http://www.drugs.com/article/anabolic-steroids.html (accessed 22 Mar 2014).
- ↑ Sagoe D, Molde H, Andreassen CS, Torsheim T, Pallesen S. The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression analysis. Annals of Epidemiology 2014. http://www.sciencedirect.com/science/article/pii/S1047279714000398 (accessed 23 Mar 2014).
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 Goodman CC, Snyder TE. Screening the Chest, Breasts, and Ribs. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. Philadelphia: Saunders, 2013. p673-712.
- ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 Goodman CC, Snyder TE. Interviewing as a Screening Tool. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. Philadelphia: Saunders, 2013. p31-95.
- ↑ Jeon B, Yoo H, Jeong E, Kim H, Jin C, Kim D, Lee J. LC-ESI/MS/MS method for rapid screening and confirmation of 44 exogenous anabolic steroids in human urine. Springer-Verlag, Anal Bioanal Chem 2011;401:1353–1363.
- ↑ Pozo O, Eenoo P, Deventer K, Delbeke F. Development and validation of a qualitative screening method for the detection of exogenous anabolic steroids in urine by liquid chromatography-tandem mass spectrometry. Springer-Verlag, Anal Bioanal Chem 2007;389:1209–1224.
- ↑ MedicineNet.com. Steroid Drug Withdrawal. http://www.medicinenet.com/steroid_withdrawal/article.htm (accessed 23 Mar 2014).
- ↑ About.com: Alcoholism. AMA Supports Anabolic Steroids Restrictions: Use of Steriods Increasing in High School Students. http://alcoholism.about.com/cs/steroids/a/blama030624.htm (accessed 23 Mar 2014).
