Endocrine Abstracts

Introduction: Growth hormone secretogogues (GHS) are popular among body building communities as muscle bulking agents. We present an interesting case of new onset diabetes induced by a combination of GHS and selective androgen receptor modulators (SARMs).

Case report: A 34-years body builder was referred by his GP due to a 3-week history of polyuria, polydipsia and fatigue. He had recently used one cycle of a combination tablet which contained Ibutamoren 20 mg (MK-677), Testolone 20 mg (RAD-140) and Ligandrol 8 mg (LGD) for 26 days. He was otherwise well with no significant past medical history. His mother, grandmother and sister have type 2 diabetes. On examination, BMI was 38.2 kg/m². His blood glucose was 27.5 mmol/l and ketones was 0.1 mmol/l. HbA1c was 102 mmol/mol. Anti-GAD, Zinc transporter and pancreatic islet cell antibodies were negative. C  peptide was 611 pmol/l (range 190-990). TSH and anti- tissue transglutaminase antibodies were normal. He was started on Metformin 500 mg BD which was later increased to 1 gram BD and Gliclazide 80 mg BD. His capillary glucose improved one week after starting treatment but did not normalise and ranged between 8-12 mmol/l. He was advised not to use GHS.

Discussion: Ibutamoren is an orally active non-peptide growth hormone (GH) secretagogue, mimicking the GH stimulating action of ghrelin. It has the potential to cause sustained activation of GH-IGF-1 axis. Available studies indicate that GHSs could raise blood glucose and HBA1c due to decrease in insulin sensitivity. In our case, onset of diabetes coincided with the use of GHS along with SARMs.

Learning points: 1. This case report shows the importance of taking thorough drug history including over the counter drugs and supplements. 2. Physicians should be mindful of the side effects of over-the-counter drugs used for body building.