Anabolic steroid hepatotoxicity: lessons to be learnt?

General practitioners' views and knowledge about anabolic steroid use-survey of GPs in a high prevalence area

The aim of this study was to assess GPs' attitudes, clinical behaviour, information needs and contact with anabolic-androgenic steroid (AAS) users in an area reported to have a high prevalence of AAS use. It was a cross-sectional study of GPs using a self-administered questionnaire. The sample comprised of 202 GPs practising in the Central Business District and inner city area of Sydney took part. Of 164 eligible GPs, 143 responded (87% response rate). Fifty-three per cent of respondents reported that they had seen at least one patient in the last year who told them they had used AASs for non-medical purposes; 6% indicated that they had seen more than 20 patients who mentioned AAS use. Two per cent of respondents reported prescribing AASs for body-building purposes and 6% indicated a willingness to do so in a hypothetical situation. Forty per cent of respondents reported that they would be willing to provide harm minimization advice to AAS users; 77% of respondents were interested in obtaining more information about AAS use, most frequently requested in the form of a fact sheet or pamphlet. Most GPs in the area surveyed had some contact with AAS users in their practice. Some GPs had favourable attitudes towards prescription of AASs for non-medical purposes. These attitudes require further exploration. The results of this survey invite a reappraisal of many policy initiatives involving GPs aimed at reducing AAS-related harm.

[Liver and sport]

The liver is a vital organ and plays a central role in energy exchange, protein synthesis as well as the elimination of waste products from the body. Acute and chronic injury may disturb a variety of liver functions to different degrees. Over the last three decades, the effects of physical activity and competitive sport on the liver have been described by various investigators. These include viral hepatitis and drug-induced liver disorders. Herein, we review acute and chronic liver diseases potentially caused by sport. Team physicians, trainers and others, responsible for the health of athletes, should be familiar with the risk factors, clinical features, and consequences of liver diseases that occur in sports.

Anabolic steroid abuse: physiological and anaesthetic considerations

This review summarises the physiological and pharmacological effects of the anabolic steroids used to enhance performance in sports. The anabolic steroids promote muscle growth and protein synthesis. Side-effects of anabolic steroids include cardiomyopathy, atherosclerosis, hypercoagulopathy, hepatic dysfunction, and psychiatric and behavioural disturbances. It is therefore appropriate that the anaesthetist be familiar with the abuse of anabolic steroids, their potential adverse effects, and the peri-operative risk associated with the use of these drugs.

Rat liver lysosomal and mitochondrial activities are modified by anabolic-androgenic steroids

PURPOSE

The aim of this study was to examine the separate and combined effects of an 8-wk treatment with high doses of 17alpha-alkylated anabolic-androgenic steroids (AAS) and exercise training on selected lysosomal and mitochondrial enzyme activities in rat liver.

METHODS

Sedentary and treadmill-trained (25 m x min(-1), 45 min x d(-1), 5 d x wk(-1)) male rats were treated with fluoxymesterone, methylandrostanolone, or stanozolol (2 mg x kg body weight(-1), 5 d x wk(-1)) for 8 wk.

RESULTS

Acid phosphatase, arylsulfatase, beta-glucuronidase, and beta-galactosidase activities were increased in liver homogenates of sedentary and trained AAS-treated rats. The mitochondrial respiratory chain activities rotenone-sensitive NADH-cytochrome c reductase (NCCR), succinate cytochrome c reductase (SCCR), and cytochrome oxidase (COX) showed a significant decrease in steroid-administered rats, whereas citrate synthase (CS), a matrix enzyme, exhibited no changes in activity, pointing to a selective effect of AAS on mitochondrial membrane complexes. In vitro studies in mitochondrial fractions isolated from the liver of control rats showed that COX and CS activities were insensitive to the AAS, whereas NCCR and SCCR activities were partly inhibited. On the other hand, the mean values of serum parameters related to hepatic function were within normal ranges in all the experimental groups of animals.

CONCLUSIONS

The present data show that 8-wk ingestion of three different anabolic-androgenic steroids, either with or without concurrent exercise training, affects lysosomal hydrolases and mitochondrial respiratory chain electron transport in rat liver without modifying classical serum indicators of hepatic function.