Posted: July 22nd, 2023

Anabolic Steroid Abuse in Adolescent Athletes: Case Study Analysis

Anabolic Steroid Abuse in Adolescent Athletes: Case Study Analysis

The case of a 17-year-old male presenting with aggressive behavior, anxiety, and paranoia raises significant concerns about potential anabolic steroid abuse. This paper examines the medical implications, associated symptoms, and other performance-enhancing methods used by athletes, with a focus on the risks and consequences for adolescents.

Medical Concerns

The patient’s presentation suggests several medical concerns that warrant immediate attention. The combination of behavioral changes, physical symptoms, and the context of intense athletic involvement point towards the possibility of anabolic steroid abuse. Liu et al. (2020) highlight that anabolic steroid use can lead to a range of psychological and physiological effects, particularly in adolescents whose bodies are still developing.

One primary concern is the potential for liver dysfunction. The patient’s icteric sclera (yellowing of the eyes) may indicate cholestatic hepatitis, a known complication of anabolic steroid use (Liu et al., 2020). This condition can lead to serious liver damage if left untreated. Additionally, the patient’s elevated blood pressure (140/82 mm Hg) is concerning, as anabolic steroids are known to affect cardiovascular health negatively.

The patient’s well-defined muscles and acne are also indicative of potential steroid use. Wallace and Lindblad (2022) note that rapid muscle gain and severe acne are common physical manifestations of anabolic steroid abuse in adolescents. Furthermore, the patient’s age raises concerns about the potential for stunted growth due to premature epiphyseal closure, a risk specifically associated with steroid use during adolescence.

Symptoms Associated with Anabolic Steroid Use

Anabolic steroid abuse can manifest through a wide array of symptoms, affecting both physical and psychological aspects of an individual’s health. In males, testicular atrophy, reduced sperm count, and alterations in sperm morphology are common (Wallace & Lindblad, 2022). Other physical symptoms may include baldness and the development of breast tissue (gynecomastia).

Psychologically, the symptoms observed in this case—aggression, anxiety, and paranoia—are typical of anabolic steroid abuse. Liu et al. (2020) report that these mood disturbances are often accompanied by irritability and even manic episodes in some cases. The patient’s hostile demeanor during the examination aligns with these documented psychological effects.

Other Performance-Enhancing Methods

While anabolic steroids are a significant concern, athletes may employ various other methods to enhance their performance. Kanayama et al. (2018) provide an overview of performance-enhancing drugs and dietary supplements commonly used by athletes. These include:

Human Growth Hormone (HGH): Used to increase body growth and strength, HGH can have serious side effects, particularly in adolescents whose growth plates have not yet closed.

Blood Doping: This involves either red cell transfusions or the use of recombinant human erythropoietin to increase oxygen-carrying capacity. Both methods carry significant risks, including blood clots and cardiovascular complications.

Creatine: While less harmful than anabolic steroids, creatine supplementation can still lead to kidney stress and dehydration if used improperly.

Ephedrine: This stimulant is sometimes used to enhance workouts but can cause dangerous cardiovascular effects.

Herbal Preparations: Various herbal supplements are marketed for performance enhancement, but many lack scientific evidence of efficacy and may have unknown side effects.

Kanayama et al. (2018) emphasize that the use of these substances, especially in combination, can lead to unpredictable and potentially dangerous health outcomes. The authors stress the importance of education and prevention strategies, particularly for young athletes who may be more susceptible to pressure from coaches or peers.

In conclusion, the case presented highlights the serious medical concerns associated with anabolic steroid abuse in adolescent athletes. The patient’s symptoms, including behavioral changes, physical manifestations, and potential liver dysfunction, strongly suggest steroid use. Healthcare providers must be vigilant in recognizing these signs and understanding the various performance-enhancing methods athletes might employ. Early intervention, education, and comprehensive care are crucial in addressing this issue and preventing long-term health consequences for young athletes.

References
Kanayama, G., Hudson, M. I., & Pope, H. G. (2018). Performance-enhancing drugs and dietary supplements used by athletes: A review of recent advances. Current Opinion in Psychiatry, 31(2), 142-149.
Liu, H., Wang, Y., Yao, W., & Liu, S. (2020). The clinical and metabolic effects of anabolic-androgenic steroid abuse. Aging, 12(11), 10822-10840.
Wallace, L. C., & Lindblad, J. (2022). Anabolic-androgenic steroid use in adolescents and young adults. Pediatrics in Review, 43(6), 344-353.

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PHARMACOLOGY/TOXICOLOGY CASE STUDY
History: A 17-year-old male presents to your emergency department with his
parents. Mom is concerned because the child has been very aggressive,
anxious and paranoid over the last week. Mom says that he is an “intense”
athlete and that the coach has convinced him he can become a
professional athlete.

PMH: None.
Physical Examination:
T: 98.6°F HR: 70 bpm RR: 14 breaths per minute BP: 140/82 mm Hg
General: Calm but hostile. Alert and oriented.
HEENT: Examination is normal. Sclera icteric.
Pulmonary: Clear to auscultation.
CV: Regular rate and rhythm without murmur.
Abdomen: Soft and nontender, bowel sounds were normal.
Neurologic: Normal deep tendon reflexes and normal muscle strength.
Musculoskeletal: He has very well defined muscles.
Skin: Acne.

QUESTIONS CASE STUDY #24
1. What medical concerns do you have?
2. What symptoms are associated with this type of medication use?
3. What other treatment may athletes use to “enhance” performance?
[51]
CASE STUDY #24: ANABOLIC STEROID ABUSE
1. You suspect that this teenager may be abusing anabolic steroids.
2. Symptoms which may be associated with the abuse of anabolic steroids are very
diverse. In males’ testicular atrophy, reduction in sperm counts and alteration in
sperm morphology, baldness, or development of breasts can occur. Females can
get growth of facial hair, male pattern baldness, changes or cessation of
menstrual cycle, or deepened voice. Adolescents may get stunted growth due to
premature epiphyseal closure and be may more susceptible for ligament or
cartilage damage. Psychologic manifestations may include aggression, anxiety,
irritability, paranoia and mania. Hepatic dysfunction may occur and is manifested
by cholestatic hepatitis. Hyperlipidemia with elevated LDL and lower HDL can
occur. Severe acne can also be seen.
3. Athletes may also take human growth hormone to enhance body growth and
increase strength. The use of red cell transfusions to increase oxygen-carrying
capacity has been reported. Others have used recombinant human erythropoietin
to increase red cell production. Other substances such as creatine, ephedrine,
or herbal preparations may be used to enhance workouts.

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