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Sudden anabolic steroid abuse-related death in athletes

2005; Elsevier BV; Volume: 114; Issue: 1 Linguagem: Inglês

10.1016/j.ijcard.2005.11.033

1874-1754

Marco Di Paolo, Manuela Agozzino, Chiara Toni, Alessandro Luciani, Luigi Orlando Molendini, Marco Scaglione, Frediano Inzani, Michele Pasotti, F Buzzi, Eloisa Arbustini,

Pharmacological Effects and Assays

Dear Editor,Androgenic anabolic steroid (AAS) abuse is increasinglywide-spreading among professionals and amateurs takingpart in sporting events, both adults and youths. AAS toxicitymay cause morbidity and mortality. Death may occursuddenly or be related to the chronic damage of vitalorgans. Few reports of sudden death (SD) in AAS abusersare available (Anabolic Steroid Abuse-Related Death,ASARD) [1–3].We describe the results of forensic autopsies andtoxicological tests in four adult athletes (two professio-nals) who died suddenly out of the hospital. Thecircumstances of death were described by witnesses fortwo victims. The positive toxicological tests (that wereperformed on biological samples taken at autopsy and/orcircumstantial data, the physical phenotype), and investi-gation among relatives, friends and colleagues proved theAAS abuse (Table 1). The levels of testosterone weretested in urine samples using gas chromatographic massspectrography (MS). The ratio between testosterone andits metabolite epitestosterone higher than six was consid-ered as consistent with exogenous assumption of testos-terone. Stanazolol was measured in urine samples usingimmunoenzymatic methods in ELISA (Neogen andBIOX). The presence of stanazolol was confirmed withHPLC/MS. The presence of cocaine, amphetamines,human chorionic gonadotropin (hCG), human growthhormone (hGH), insulin and other drugs was excluded.Alcoholic levels were within normal ranges. There wereno prior medical history of illnesses, and of family historyof cardiomyopathies, sudden death and coronary arterydisease under the age of 50 years. The four athletes hadregular evaluations for sport activity according to theItalian laws for agonistic (DM 18/2/82, GU #98, 05/03/82) and non-agonistic athletes (DM 28/02/83, GU #72,15/03/83).At autopsy, the four cases shared the followingfindings: absence of asymmetrical left ventricular hyper-trophy, of coronary atherosclerosis causing significantluminal narrowing, pulmonary thromboembolism, coronaryand endocavitary thrombi, and inflammatory infiltrates.Cardiac valves were normal. The histopathologic studyshowed myocardial damage characterised by myocytehypertrophy, focal myocyte damage with myofibrillar loss,interstitial fibrosis, mostly at the subepicardial, and smallvessel disease (Table 1, Fig. 1). Other organ/tissue findingswere unremarkable.