Adolescent, Anabolic Steroids
The adolescent girl described in the vignette probably is using anabolic
steroids. Many athletes use performance-enhancing drugs to supplement their
training, although there may not be a noticeable increase
in muscle size and strength. Anabolic steroids are
synthetic derivatives of testosterone and can be injected or taken orally,
frequently at 10 times the recommended therapeutic drug dose. Combinations
of oral and injectable agents often are used concurrently in 6- to 12-week
cycles, which is known as "stacking."
Growth hormone (GH) also is used to enhance athletic performance, although not
as commonly as anabolic steroids. It is claimed that its use
increases protein anabolism, enhances tissue repair, and
increases fat metabolism. GH is particularly
attractive among athletes because it is not commonly detected in current drug
testing procedures.
Anabolic steroid and GH use can be diagnosed by careful history and physical
examination. All athletes, whether in organized sports or
individual bodybuilding, should be asked about the use of performance-enhancing
drugs. Other high-risk behaviors should be reviewed at the same time
because there is an increased use of other illicit drugs with anabolic steroid
use. Obvious signs of virilization in females on
physical examination should not be relied upon to distinguish the user from the
nonuser, but the presence of acne,
deepening of the voice, and
hirsutism in a female or gynecomastia and a high
voice in a male should make the examiner suspicious.
Hypogonadism or a decrease in testicular size also can be seen in the
male user. Other side effects associated with steroid use include
hypertension,
hyperaggressiveness, mood swings,
psychosis, and mania.
Depression can occur during drug withdrawal.
The laboratory evaluation of anabolic steroid use involves both specific and
nonspecific data. Orally administered steroids may be
present in the urine for days to weeks; injected steroids can be
present for 6 months or longer. Nonspecific evidence of anabolic steroid
use may include elevated liver enzyme
concentrations, decreased high-density and increased low-density lipoprotein
cholesterol levels, oligospermia, and
azoospermia. In addition, prepubertal athletes may
have premature epiphyseal closure.
Arrhythmias, seizures, and weight loss are not associated
with anabolic steroid use. Although psychosis may be seen, hallucinations
are not a common side effect.
References:
American Academy of Pediatrics Committee on Sports Medicine and
Fitness. Adolescents and anabolic steroids: a subject review.
Pediatrics. 1997;99:904-908
Fishman M, Bruner A, Adger H Jr. Substance abuse among children and
adolescents. Pediatr Rev. 1997;18:394-403
Foley JD, Schydlower M. Anabolic steroid and ergogenic drug use by
adolescents. Adolesc Med. 1993;4:341-352
Neinstein LS, Heischober BS. Miscellaneous drugs (anabolic steroids).
In: Neinstein LS, ed. Adolescent Health Care: A Practical Guide. 3rd
ed. Baltimore, Md: Williams & Wilkins; 1996:1067-1068