Has stroke been associated with use of anabolic steroids?/nA 53-year-old body-builder has been usin

Fråga: Has stroke been associated with use of anabolic steroids? A 53-year-old body-builder has been using anabolic steroids for many years. The most recent use was testosterone (Sustanon) for 5 months. The patient developed dysphasia, facial paralysis and apraxia in the right arm. A computed tomography of the brain was consistent with a cerebral infarction. All symptoms remained for several days. Later on the symptoms disappeared except for the speech difficulties.

Sammanfattning: Stroke, particularly cerebral infarction, with or without haemorrhage is a relatively frequently described adverse reaction in patients treated with anabolic steroids and in young men who have been using anabolic steroids in sports. The fact that anabolic steroids affect the cardiovascular system via a known mechanism strengthen the cause-relationship, but well conducted epidemiological studies estimating the risk of cerebrovascular events after treatment or other use of anabolic steroids are lacking.

Svar: A literature search on Medline provided a series of articles describing cerebrovascular events in use and abuse of anabolic steroids(1, 6-13).

The mechanisms behind such adverse events have been discussed. One explanation suggested is based on the experimental evidence that testosterone stimulates thrombus formation by supressing prostacyclin (PGI2) formation in arterial smooth muscles in rats (1). The actions of prostacyclins in humans are vasodilatation, inhibition of platelet aggregation and fibrinolysis (2).

Testosterone-like compounds also increase the erythropoesis by increasing synthesis of erythropoetin in the kidneys and other tissues resulting in an increase in hematocrit (3).

A decrease of high-density lipoprotein (HDL) levels and an increase of low-density lipoproteins/cholesterol levels are other known side effects due to anabolic steroids (4). Pathological cardiovascular and cerebrovascular changes are therefore possible. The drug information centres have received several questions concerning the use and abuse of anabolic steroids and cerebrovascular diseases, one of which discusses the events in detail (5).

A search on Medline revealed five papers describing case reports of cerebrovascular events related to treatment with various anabolic steroids (6-10).

One case report described transient ischemic attack in one patient with protein-C-deficiency after treatment with stanozolol 5 mg daily for at least 8 weeks (6).

Another paper concerns three case reports. One man and two women, between 26 and 52 years of age, had superior sagital sinus thrombosis after treatment of hypoplastic anemia with fluoxymesterone 30-60 mg daily or methenolone-enanthate 300 mg twice daily for several months for (7). In another case report cerebral haemorrhage is described in a 22-year-old man treated with oxymetholone 40 mg daily for at least 2 months (8).

A significant increase in hematocrit in 15 men with hypogonadism, 52 to 78 years old, was seen after treatment with testosterone enanathate 300 mg every three weeks for several months (9).

The same phenomenon was described in a 21-year-old man given testosterone enanthate 200 mg every two weeks on the same indication (10).

A further search on Medline revealed five more case reports of cerebrovascular events in otherwise healthy men who had used various anabolic steroids in sports.

Two case reports describe cerebral haemorrhage in men 27 and 28 years old, both with a history of myocardial infarction some months before the event (11-12). In three other case reports, cerebral infarction in men between 21 and 34 years of age who have been using various anabolic steroids are described (1,4,13).