Endocrine Abstracts

Anabolic androgenic steroids (AAS) are class C drugs with adverse effects on health. Prevalence is increasing, often with a lack of awareness of the dangers. We present the case of a 33 year-old male with dilated cardiomyopathy and polycythaemia apparently due to AAS abuse over three years. The patient presented with five weeks of increasing breathlessness and chest tightness. Examination revealed evidence of congestive cardiac failure. Chest radiograph showed evidence of pulmonary oedema and cardiomegaly and electrocardiogram showed evidence of left ventricular hypertrophy. Biochemistry showed polycythaemia with haemoglobin of 196g/l (130-170) and haematocrit 0.61. Liver enzymes were raised - alanine transaminase 79IU/l (0-35) Cardiac MRI revealed a severely dilated left ventricle with concentric hypertrophy and significantly increased cardiac mass of 380g (mean average 145g). Left ventricular contractility was severely impaired with an ejection fraction of 10-15% and no regional wall motion abnormality. Myeloproliferative neoplasm panel was negative and erythropoietin was normal. Testosterone was 52 nmol/l (10-29) with completely suppressed gonadotrophins. Despite an initial denial of illicit drug use the patient conceded use of AAS supplied by a personal trainer. The patient was unaware of the health consequences AAS abuse and was distressed to learn of the implication on fertility. Although he was a weight lifter he reported that his motivation to take AAS had been low mood and the regimen was recommended by a personal trainer. Treatment consisted of intravenous diuresis and standard treatment for dilated cardiomyopathy. Regular venesection was required for 6 weeks. Ejection fraction improved to 30% over the following 6 months. He was able to return to the gym but expressed temptation to take androgens again despite now being aware of the dangers, and his desire to start a family. He was referred to psychological services. At 4 months testosterone was still low at 4.2 nmol/l.