ABUSE & MISUSE OF STEROIDS

MADIHA AHMED 11761

DRUG ABUSE:Drug or other material that are administered in a pattern and amount that interferes

with health and normal social and occupational functioning of the individual.

Steroids (also known as cortisone or corticosteroids) are chemicals (hormones) that occur naturally in the body.

Steroids decrease inflammation, suppress the body's immune system, block DNA from being made, as well as blocking a chemical called histamine

(released during an allergic reaction). Steroid medicines are man-made but are similar to these natural hormones.

STEROIDS

TYPES:There are three different types of steroids used nowadays.

– Anabolic steroid• Are the most commonly abused steroid• Function: To increase muscle mass and strength

– Corticosteroid• Artificially made cortisone, cortisone is naturally produced in your body .• Function: medically injected to reduces inflammation and injury.

– Androgenic steroid• Has anabolic effects on bones, skeletal muscle and vocal chords.• Function: To help treat hereditary angioedema, Behçet’s disease and aplastic

anemia

USE:Commonly prescribed corticosteroid medications, like Prednisone, Prednisolone, and Dexamethasone are available to be taken by mouth, intravenously, or by intramuscular injection and may be used to treat diseases like asthma, rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus in which inflammation is part of the disease process. The use of steroid ointments and creams on the skin, like Triamcinolone and Betamethasone, is common in the treatment of dermatitis .

STEROIDS USE AND ABUSE :

ABUSE:The abuse of steroids continues to make news and sports headlines as athletes and bodybuilders use them illegally to gain an advantage on the playing field. Anabolic steroids refer to hormones that are either taken orally or by injection that influence the body's hormonal system to produce extra testosterone. The goal of taking anabolic steroids is to increase muscle mass. Anabolic refers to this muscle-building capability. Anabolic steroids should not be confused with corticosteroids, which are used routinely as anti-inflammatory medications.

STEROIDS WITHDRAWL FACTS : Synthetic cortisone medications (corticosteroids) simulate cortisol, a naturally occurring, anti-inflammatory hormone produced by the adrenal glands. Such drugs (for example, prednisone) have since benefited many, but are not without potential side effects. The two major problems related to continuous steroid treatment are:drug side effects and symptoms due to changes in the balance of normal hormone secretion (withdrawal symptoms). The production of corticosteroids is controlled by a "feedback mechanism," involving the adrenal glands, the pituitary gland and brain. Known as the "Hypothalamic-Pituitary-Adrenal Axis" (HPAA). Using large doses for a few days, or smaller doses for more than two weeks, leads to a prolonged decrease in HPAA function. Steroid use cannot be stopped abruptly; tapering the drug gives the adrenal glands time to return to their normal patterns of secretion. Withdrawal symptoms (weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain) can mimic many other medical problems. Some may be life-threatening. Tapering may not completely prevent withdrawal symptoms. Steroid withdrawal may involve many factors, including a true physiological dependence on corticosteroids. Patients should carry a list of all your medications in your wallet to alert medical personnel in case of emergency. Supplementation with corticosteroid medication may be needed during periods of stress (such as surgery), even up to a year after stopping corticosteroid therapy .

Steroid withdrawal symptoms can mimic many other medical problems.

Weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea (which can lead to fluid and electrolyte abnormalities), and abdominal pain are common. Blood pressure can become too low, leading to dizziness or fainting. Blood sugar levels may drop. Women also may note menstrual changes. Less often, joint pain, muscle aches, fever, mental changes, or elevations of calcium may be noted. Decrease in gastrointestinal contractions can occur, leading to dilation of the intestine (ileus).

WITHDRAWL SYMPTOMS :

DIAGNOSIS :

Often steroids remain in the body for prolonged periods of time and can be detected by urine drug tests. It is possible that certain designer steroid drugs may escape detection because they are built to be less detectable. Sometimes the steroid itself is not found but drugs that are used as masking agents are. Bumetanide and furosemide are diuretics, or water pills, that may cause a false-negative test. For professional and elite athletes, the presence of these masking drugs in a urine sample is also considered a failed test.

Emerging testsshow all

Test Resulturine toxicology testing Should be ordered in all patients with suspected steroid abuse.Exogenous androgens other than testosterone can be detected by gas chromatography with mass spectrometry.Oral androgens can be detected for 1 month after administration. Injections may be detectable for 6 to 8 months and perhaps up to 12 months after administration. [44]

positive for exogenous androgens (except testosterone)

testosterone to epitestosterone ratio Should be ordered in all patients with suspected steroid abuse.Determines urinary ratio of testosterone glucuronide to epitestosterone glucuronide.Normally the ratio is 1 to 3:1. The World Anti-Doping Agency considers a ratio >4:1 to be positive for 'doping' (use of performance-enhancing drugs). Patients taking exogenous testosterone will have higher ratios (>6:1).

>6:1 in patients taking exogenous testosterone

serum LH and FSH Should be ordered in all patients with suspected steroid abuse.Steroids inhibit production and release of LH and FSH. [44]

decreased

FBC Should be ordered in all patients with suspected steroid abuse.Steroids stimulate erythropoiesis and increase platelet aggregation.

elevated RBC count, haemoglobin, haematocrit, WBC count, platelets

serum glucose Should be ordered in all patients with suspected steroid abuse.Steroids tend to increase serum glucose when taken in supra-therapeutic doses.

elevated

serum electrolytes Should be ordered in all patients with suspected steroid abuse.Steroids cause sodium and water retention. Hypernatraemia increases rate of potassium and hydrogen ion excretion.Metabolic derangements may occur (alkalosis and compensatory respiratory acidosis).Electrolytes should be obtained especially in athletes who use diuretics. These values are likely to be normal in most athletes.

normal or deranged

lipid panel Should be ordered in all patients with suspected steroid abuse.HDL may be decreased. LDL may be increased. Cholesterol may be increased, decreased, or normal.These effects are particularly observed with orally active steroids and are less prominent with injectable steroids.

normal or deranged

LFTs Should be ordered in all patients with suspected steroid abuse.AST or ALT may be elevated, indicating liver damage (rare) or breakdown of skeletal muscle (common).Gamma-GT is unique to the liver and is not present in muscle; therefore, elevated gamma-GT in a steroid user should raise a genuine concern of liver damage. It is reported to be the most distinctive enzyme for the detection of hepatic dysfunction in exercising patients. [45]

elevated

CK Should be ordered in all patients with suspected steroid abuse.Heavy exercise may induce muscle damage and rhabdomyolysis in steroid users.

normal or elevated

hepatitis serology Needle sharing places patients at risk of contracting infectious diseases.

positive or negative

HIV serology Needle sharing places patients at risk of contracting infectious diseases.

positive or negative

Test Result

Urine toxicology testing should be ordered in all patients with suspected steroid abuse. Exogenous androgens other than testosterone can be detected by gas chromatography with mass spectrometry. Oral androgens can be detected for 1 month after administration. Injections may be detectable for 6 to 8 months and perhaps up to 12 months after administration.

positive for exogenous androgens (except testosterone)

Testosterone to epitestosterone ratio should be ordered in all patients with suspected steroid abuse.Determines urinary ratio of testosterone glucuronide to epitestosterone glucuronide. Normally the ratio is 1 to 3:1. The World Anti-Doping Agency considers a ratio >4:1 to be positive for 'doping' (use of performance-enhancing drugs). Patients taking exogenous testosterone will have higher ratios (>6:1).

>6:1 in patients taking exogenous testosterone

serum LH and FSH should be ordered in all patients with suspected steroid abuse. Steroids inhibit production and release of LH and FSH.

Decreased

FBC should be ordered in all patients with suspected steroid abuse.Steroids stimulate erythropoiesis and increase platelet aggregation.

elevated RBC count, haemoglobin, haematocrit, WBC count, platelets

Serum glucose should be ordered in all patients with suspected steroid abuse.Steroids tend to increase serum glucose when taken in supra-therapeutic doses.

elevated

TEST RESULT

serum electrolytes Should be ordered in all patients with suspected steroid abuse.Steroids cause sodium and water retention. Hypernatraemia increases rate of potassium and hydrogen ion excretion.Metabolic derangements may occur (alkalosis and compensatory respiratory acidosis).Electrolytes should be obtained especially in athletes who use diuretics. These values are likely to be normal in most athletes.

normal or deranged

lipid panel Should be ordered in all patients with suspected steroid abuse.HDL may be decreased. LDL may be increased. Cholesterol may be increased, decreased, or normal.These effects are particularly observed with orally active steroids and are less prominent with injectable steroids.

normal or deranged

LFTs Should be ordered in all patients with suspected steroid abuse.AST or ALT may be elevated, indicating liver damage (rare) or breakdown of skeletal muscle (common).Gamma-GT is unique to the liver and is not present in muscle; therefore, elevated gamma-GT in a steroid user should raise a genuine concern of liver damage. It is reported to be the most distinctive enzyme for the detection of hepatic dysfunction in exercising patients. [45]

elevated

CK Should be ordered in all patients with suspected steroid abuse.Heavy exercise may induce muscle damage and rhabdomyolysis in steroid users.

normal or elevated

hepatitis serology Needle sharing places patients at risk of contracting infectious diseases. positive or negativeHIV serology Needle sharing places patients at risk of contracting infectious diseases. positive or negative

Serum electrolytes should be ordered in all patients with suspected steroid abuse.Steroids cause sodium and water retention. Hypernatraemia increases rate of potassium and hydrogen ion excretion. Metabolic derangements may occur (alkalosis and compensatory respiratory acidosis).Electrolytes should be obtained especially in athletes who use diuretics. These values are likely to be normal in most athletes.

normal or deranged

Lipid panel should be ordered in all patients with suspected steroid abuse. HDL may be decreased. LDL may be increased. Cholesterol may be increased, decreased, or normal.These effects are particularly observed with orally active steroids and are less prominent with injectable steroids.

normal or deranged

LFTs should be ordered in all patients with suspected steroid abuse. AST or ALT may be elevated, indicating liver damage (rare) or breakdown of skeletal muscle (common). Gamma-GT is unique to the liver and is not present in muscle; therefore, elevated gamma-GT in a steroid user should raise a genuine concern of liver damage. It is reported to be the most distinctive enzyme for the detection of hepatic dysfunction in exercising patients.

elevated

CK should be ordered in all patients with suspected steroid abuse.Heavy exercise may induce muscle damage and rhabdomyolysis in steroid users.

normal or elevated

Hepatitis serology needle sharing places patients at risk of contracting infectious diseases.

positive or negative

HIV serology needle sharing places patients at risk of contracting infectious diseases.positive or negative

TEST RESULTS

Nuclear medicine cardiovascular imaging Emerging nuclear medicine imaging modalities may improve our ability to diagnose cardiovascular pathologies due to androgenic anabolic steroid (AAS) use. Imaging techniques currently being investigated include PET, MRI, single-photon emission computed tomography (SPECT), and echocardiography.

cardiovascular pathology

TEST RESULT

EMERGING TESTS: