Endocrine Abstracts

Introduction: Performance-enhancing drug (PED) use is currently a common practice both inside and outside the sports competition scenario, and its adverse health effects remain underappreciated.

Case report: We report the case of a 26-year-old man, bodybuilding practitioner, no relevant medical history, family history of autoimmune disorders. Referred to the emergency room with polydipsia, polyuria, blurred vision associated with a post-prandial capillary blood glucose of 422 mg/dl. Initial testing revealed glucose 281 mg/dl, normal liver tests and renal function, no acidosis, no significant ketonemia. He had participated in a bodybuilding competition four days before and used the following PED (6 weeks cycle before the competition): androgenic-anabolic steroids – testosterone cypionate 500 mg/wk, trenbolone 100 mg every other day, stanozolol 40 mg id, boldenone 1200 mg/wk, sustanon® 250 mg twice weekly, testosterone enanthate 250 mg id, drostanolone propionate 100 mg every other day, mesterolone 25 mg 4-6id, fluoxymesterone 75 mg id; dopaminergic agonist – cabergoline 0.25 mg every other day; aromatase inhibitor – anastrozole 1 mg id; beta 2-adrenergic receptor agonist – clenbuterol tid; thyroid hormones – levothyroxine 100 mcg id, liothyronine 25 mcg bid; non-specified multivitamins. On the day of the competition, he took diuretics (altizide + spironolactone). He had done similar cycles since he was 21 years old. Hospitalized for suspected diabetes Mellitus (DM). Body mass index 21.1 kg/m², with fat mass 2.7 kg (5.5–13.7) and lean mass 61.8 kg (52–60.2). He maintained blood glucose 70–130 mg/dl. Hematocrit was increased (53%). A posterior analytic evaluation revealed oral glucose tolerance test with impaired glucose tolerance, positive diabetes autoimmunity, A1c 5.8%, C peptide 1.7 ng/ml (1.0–7.6). Autoimmune thyroiditis was also detected, with mild subclinical hypothyroidism. Pituitary function assessment showed hypogonadotropic hypogonadism (total testosterone 0.9 ng/dl), without evident signs or symptoms. He maintains irregular follow-up.

Discussion: A wide range of endocrine adverse effects of PED use are described. Altered glucose homeostasis can occur through increasing insulin resistance, which can accelerate DM natural history in individuals with positive autoimmunity. Anabolic steroid-induced hypogonadism is caused mainly by feedback suppression of the hypothalamic-pituitary-gonadal axis and can be irreversible, leading to infertility. Although complications related to PED use are known, there is scant scientific evidence regarding the long-term consequences and complex endocrine disruption likely caused by the stacking and cycling of multiple high-dose synthetic androgens and other classes of PED. Clinical and hormonal function evaluation of these athletes is difficult, as they are using unregulated or non-authorized drugs and can have a low level of trust in the medical community.