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
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.
 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
STEROIDS USE AND ABUSE :
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 .
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
. 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 .
WITHDRAWL SYMPTOMS :
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).
Emerging testsshow all

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.
 TEST RESULT
Test Result

Test Result

Urine toxicology testing should be ordered in all patients with suspected steroid
urine toxicology testing
Should be ordered in all
patients with suspected
steroid abuse.
Exogenous androgens other
than testosterone can be

abuse. Exogenous androgens other than testosterone can be detected by gas

detected by gas

spectrometry.
Oral androgens can be
positive for exogenous
chromatography with mass positive for exogenous
androgens (except
testosterone)
detected for 1 month after

chromatography with mass spectrometry. Oral androgens can be detected for 1

administration.
Injections may be
detectable for 6 to 8
months and perhaps up to
12 months after
androgens (except
month after administration. Injections may be detectable for 6 to 8 months and testosterone)
administration. [44]
testosterone to
epitestosterone ratio
Should be ordered in all
patients with suspected

perhaps up to 12 months after administration.

steroid abuse.
Determines urinary ratio of
testosterone glucuronide to
epitestosterone
glucuronide. >6:1 in patients taking
Normally the ratio is 1 to exogenous testosterone
3:1. The World Anti-Doping
Agency considers a ratio
>4:1 to be positive for
'doping' (use of

Testosterone to epitestosterone ratio should be ordered in all patients with

performance-enhancing
drugs). Patients taking
exogenous testosterone will
have higher ratios (>6:1).
serum LH and FSH Should

suspected steroid abuse.Determines urinary ratio of testosterone glucuronide to

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

epitestosterone glucuronide. Normally the ratio is 1 to 3:1. The World Anti- >6:1 in patients taking
[44]
FBC Should be ordered in
all patients with suspected
elevated RBC count,
steroid abuse.
haemoglobin, haematocrit,
Steroids stimulate
WBC count, platelets

Doping Agency considers a ratio >4:1 to be positive for 'doping' (use of exogenous testosterone
erythropoiesis and increase
platelet aggregation.
serum glucose Should be
ordered in all patients with
suspected steroid abuse.
elevated

performance-enhancing drugs). Patients taking exogenous testosterone will have

Steroids tend to increase
serum glucose when taken
in supra-therapeutic doses.
serum electrolytes Should
be ordered in all patients

higher ratios (>6:1).

with suspected steroid
abuse.
Steroids cause sodium and
water retention.
Hypernatraemia increases
rate of potassium and
hydrogen ion excretion.
normal or deranged
Metabolic derangements
may occur (alkalosis and
compensatory respiratory

serum LH and FSH should be ordered in all patients with suspected steroid
acidosis).
Electrolytes should be
obtained especially in
athletes who use diuretics.
These values are likely to be Decreased
abuse. Steroids inhibit production and release of LH and FSH.
normal in most athletes.
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 or deranged
normal.
These effects are
particularly observed with
orally active steroids and
are less prominent with
elevated RBC count,
injectable steroids.

FBC should be ordered in all patients with suspected steroid abuse.

LFTs Should be ordered in
all patients with suspected
steroid abuse.
AST or ALT may be elevated,
haemoglobin,
indicating liver damage

Steroids stimulate erythropoiesis and increase platelet aggregation.

(rare) or breakdown of
skeletal muscle (common).
Gamma-GT is unique to the
liver and is not present in
muscle; therefore, elevated
elevated
haematocrit, WBC
count, platelets
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]
CK Should be ordered in all

Serum glucose should be ordered in all patients with suspected steroid abuse.
patients with suspected
steroid abuse.
Heavy exercise may induce normal or elevated
muscle damage and
rhabdomyolysis in steroid
elevated
Steroids tend to increase serum glucose when taken in supra-therapeutic doses.
users.
hepatitis serology Needle
sharing places patients at
risk of contracting
infectious diseases.
positive or negative

HIV serology Needle sharing

places patients at risk of
positive or negative
contracting infectious
diseases.
 TEST RESULTS

Serum electrolytes should be ordered in all patients with suspected steroid abuse.
Steroids cause sodium and water retention. Hypernatraemia increases rate of potassium
normal or
and hydrogen ion excretion. Metabolic derangements may occur (alkalosis and
serum electrolytes Should be ordered in all patients with suspected steroid abuse. deranged
compensatory respiratory acidosis).Electrolytes
Steroids cause sodium and water retention.
should be obtained especially in athletes
who use diuretics.
Hypernatraemia These
increases rate ofvalues
potassiumare
and likely
hydrogentoionbe normal in most athletes.
excretion.
Metabolic derangements may occur (alkalosis and compensatory respiratory normal or deranged
Lipid panel should be ordered in all patients with suspected steroid abuse. HDL
acidosis). may be
Electrolytes should be obtained especially in athletes who use diuretics.
decreased.
These valuesLDL may
are likely benormal
to be increased. Cholesterol may be increased, decreased, or
in most athletes. normal or
normal.These effects
lipid panel Should be ordered in all patientsare particularly
with suspected steroid abuse. observed with orally active
HDL may be decreased. LDL may be increased. Cholesterol may be increased, decreased, or normal.
steroids and are less
normal or deranged
deranged
prominent with injectable steroids.
These effects are particularly observed with orally active steroids and are less prominent with injectable steroids.

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).
LFTs should be ordered in all patients with suspected steroidelevated abuse. AST or ALT may be
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
elevated, indicating liver damage (rare) or breakdown of skeletal muscle (common).
exercising patients. [45]

CK Should be ordered in all patients with suspected steroid abuse.

Gamma-GT is unique
Heavy exercise may induce muscle damage andtorhabdomyolysis
the liver and
in steroid users.is not present in muscle; therefore, elevated
normal or elevated
elevated
gamma-GT in a steroid user should raise a genuine concern positive
hepatitis serology Needle sharing places patients at risk of contracting infectious diseases.
HIV serology Needle sharing places patients at risk of contracting infectious diseases.
of liver damage. It is
or negative
positive or negative

reported to be the most distinctive enzyme for the detection of hepatic dysfunction in
exercising patients.
CK should be ordered in all patients with suspected steroid abuse. normal or
Heavy exercise may induce muscle damage and rhabdomyolysis in steroid users. elevated
Hepatitis serology needle sharing places patients at risk of contracting infectious positive or
diseases. negative
positive or
HIV serology needle sharing places patients at risk of contracting infectious diseases.
negative
 EMERGING TESTS:

TEST RESULT
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 cardiovascular pathology
techniques currently being investigated include PET,
MRI, single-photon emission computed tomography
(SPECT), and echocardiography.