ABUSE & MISUSE

OF STEROIDS

MADIHA
AHMED
 DRUG
Drug or other material that areABUSE:
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
Synthetic cortisone medications (corticosteroids) simulate cortisol, a naturally occurring, anti-
FACTS
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
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).
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

Urine toxicology testing should be ordered in all patients with suspected steroid
Test Result
urine toxicology testing
Should be ordered in all
patients with suspected
steroid abuse.

abuse. Exogenous androgens other than testosterone can be detected by gas positive for exogenous
Exogenous androgens other
than testosterone can be
detected by gas
chromatography with mass positive for exogenous
spectrometry. androgens (except

chromatography with mass spectrometry. Oral androgens can be detected for 1 androgens (except
Oral androgens can be testosterone)
detected for 1 month after
administration.
Injections may be

month after administration. Injections may be detectable for 6 to 8 months and

detectable for 6 to 8

testosterone)
months and perhaps up to
12 months after
administration. [44]
testosterone to

perhaps up to 12 months after administration.

epitestosterone ratio
Should be ordered in all
patients with suspected
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

Testosterone to epitestosterone ratio should be ordered in all patients with

>4:1 to be positive for
'doping' (use of
performance-enhancing
drugs). Patients taking
exogenous testosterone will

suspected steroid abuse.Determines urinary ratio of testosterone glucuronide to

have higher ratios (>6:1).
serum LH and FSH Should
be ordered in all patients
with suspected steroid
abuse.

epitestosterone glucuronide. Normally the ratio is 1 to 3:1. The World Anti-

decreased
Steroids inhibit production
and release of LH and FSH.
[44]
>6:1 in patients taking
Doping Agency considers a ratio >4:1 to be positive for 'doping' (use of exogenous testosterone
FBC Should be ordered in
all patients with suspected

elevated RBC count,

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

steroid abuse.

haemoglobin, haematocrit,
Steroids stimulate
WBC count, platelets

higher ratios (>6:1).

erythropoiesis and increase
platelet aggregation.
serum glucose Should be
ordered in all patients with
suspected steroid abuse.
elevated
Steroids tend to increase
serum glucose when taken
in supra-therapeutic doses.
serum electrolytes Should
be ordered in all patients

serum LH and FSH should be ordered in all patients with suspected steroid
with suspected steroid
abuse.
Steroids cause sodium and

Decreased
water retention.
Hypernatraemia increases

abuse. Steroids inhibit production and release of LH and FSH.

rate of potassium and
hydrogen ion excretion.
normal or deranged
Metabolic derangements
may occur (alkalosis and
compensatory respiratory
acidosis).
Electrolytes should be
obtained especially in
athletes who use diuretics.

elevated RBC count,

These values are likely to be
normal in most athletes.
lipid panel Should be
ordered in all patients with
suspected steroid abuse.

FBC should be ordered in all patients with suspected steroid abuse. haemoglobin,
HDL may be decreased. LDL
may be increased.
Cholesterol may be
increased, decreased, or normal or deranged
normal.

Steroids stimulate erythropoiesis and increase platelet aggregation. haematocrit, WBC

These effects are
particularly observed with
orally active steroids and
are less prominent with
injectable steroids.

count, platelets
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
elevated

Serum glucose should be ordered in all patients with suspected steroid abuse.
muscle; therefore, elevated
gamma-GT in a steroid user

elevated
should raise a genuine
concern of liver damage. It
is reported to be the most

Steroids tend to increase serum glucose when taken in supra-therapeutic doses.

distinctive enzyme for the
detection of hepatic
dysfunction in exercising
patients. [45]
CK Should be ordered in all
patients with suspected
steroid abuse.
Heavy exercise may induce normal or
elevated muscle damage and
rhabdomyolysis in steroid
users.
hepatitis serology Needle
sharing places patients at
positive or negative
risk of contracting
 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
and hydrogen ion excretion. Metabolic derangements may occur (alkalosis and normal or
compensatory respiratory acidosis).Electrolytes should be obtained especially in athletes deranged
who use diuretics. These values are likely to be 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
normal.These effects are particularly observed with orally active steroids and are less deranged
prominent with injectable steroids.

LFTs should be ordered in all patients with suspected steroid abuse. AST or ALT may be
elevated, indicating
[45] 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 elevated
reported to be the most distinctive enzyme for the detection of hepatic dysfunction in
HIV serology Needle sharing places patients at risk of contracting infectious diseases.

positive or negative

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 RESUL
T
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.