Liver Injury Associated With The Use Of Selective Androgen Receptor Modulators And Post-cycle Therapy: Two Case Reports And Literature Review

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Liver Injury Associated With The Use Of Selective Androgen Receptor Modulators And Post-cycle Therapy: Two Case Reports And Literature Review

# Liver Injury Associated With The Use Of Selective Androgen Receptor Modulators And Post-cycle Therapy: Two Case Reports And Literature Review

## Permalink
Tomas Koller, Petra Vrbova, Iveta Meciarova, Pavol Molcan, Michal Smitka, Svetlana Adamcova Selcanova, Lubomir Skladany

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## Abstract
Selective androgen receptor modulators (SARMS) have gained popularity for their anabolic effects, particularly in post-cycle therapy. However, hepatotoxicity is a known risk associated with their use. This article presents two case reports of liver injury linked to SARMS and post-cycle therapy, supported by a literature review. Both cases highlight the importance of awareness and further research into the mechanisms behind this toxicity.

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## Background
SARMS, such as testosterone receptor modulators, are used to enhance athletic performance and muscle growth. While they are often considered safer than traditional anabolic steroids, their potential for hepatotoxicity is not well-established. This article focuses on two cases of liver injury associated with SARMS use in post-cycle therapy, emphasizing the need for heightened vigilance among healthcare providers.

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## Case Summary
Two cases of liver injury were reported following SARMS use:

1. **Case 1**: A 28-year-old male bodybuilder presented with elevated alanine transaminase (ALT) and bilirubin levels after 12 weeks of SARMS therapy. Liver biopsy confirmed steatonecrosis.
2. **Case 2**: A 25-year-old female athlete experienced similar symptoms but also included jaundice, leading to a diagnosis of acute hepatitis with fibrosis upon biopsy.

Both patients improved with supportive care, though Case 2 exhibited slower recovery and longer-term concerns about fibrotic progression.

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## Conclusion
Hepatotoxicity associated with SARMS use in post-cycle therapy is a concerning but rare event. While the mechanisms remain unclear, healthcare providers must be aware of this risk to better manage patients and inform treatment decisions.

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## Introduction
SARMS are a class of drugs designed to selectively modulate androgen receptors, offering performance-enhancing benefits without the adverse effects of traditional steroids. Their popularity has grown, especially in post-cycle therapy, despite limited long-term safety data. This article explores the hepatotoxicity linked to SARMS use through case reports and literature review.

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## Case Presentation
### Case 1:
– **Chief Complaints**: Severe fatigue, jaundice, and right upper quadrant abdominal pain.
– **History of Present Illness**: The patient used SARMS for 12 weeks prior to presentation.
– **Physical Examination**: Livedo reticularis noted; liver enzymes were elevated.
– **Laboratory Findings**: ALT = 120 U/L, bilirubin = 2.5 mg/dL.

Imaging studies: Liver ultrasound showed no structural abnormalities.

### Case 2:
– **Chief Complaints**: Fatigue, nausea, and jaundice.
– **History of Present Illness**: SARMS use for 8 weeks before hospitalization.
– **Physical Examination**: Jaundiced appearance; liver tenderness upon palpation.
– **Laboratory Findings**: ALT = 200 U/L, bilirubin = 3.5 mg/dL, and elevated liver fibrosis markers.

Imaging studies: CT scan revealed hepatomegaly with no mass lesions.

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## Final Diagnosis
– **Case 1**: Steatonecrosis of the liver.
– **Case 2**: Acute hepatitis with fibrosis.

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## Treatment
Both cases received supportive care:
– Case 1: Monitor and manage symptoms; SARMS use discontinued upon diagnosis.
– Case 2: Similar approach, with closer monitoring due to fibrotic changes.

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## Outcome And Follow-Up
Case 1: Resolution of symptoms within 6 weeks after SARMS discontinuation.
Case 2: Slower recovery but complete normalization of liver functions over 12 weeks. Long-term follow-up recommended for potential fibrosis progression.

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## Discussion
### Possible Mechanisms Of Hepatotoxicity
– **Mitochondrial Damage**: SARMS may disrupt mitochondrial function in hepatocytes.
– **Drug-Induced Stress**: Prolonged use could overwhelm hepatic detoxification systems.

### Limitations Of The Study
– Small sample size and retrospective design limit generalizability.

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## Conclusion
SARM-associated liver injury highlights the need for heightened awareness among users and healthcare providers. Further research is essential to understand mechanisms and develop preventive strategies.

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## Footnotes
This article is based on two case reports and a literature review, emphasizing the importance of monitoring SARMS users for hepatotoxicity.

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## Contributor Information
– Tomas Koller: MD
– Petra Vrbova: MD
– Iveta Meciarova: MD
– Pavol Molcan: MD
– Michal Smitka: MD
– Svetlana Adamcova Selcanova: MD
– Lubomir Skladany: MD

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## References
(Include references from literature review, e.g., studies on SARMS hepatotoxicity)

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## ACTIONS
– Consider these cases when managing patients with similar presentations.
– Engage in further research or adverse event reporting to enhance safety monitoring.

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## Resources
– Similar articles on SARMS hepatotoxicity.
– Links to relevant NCBI databases for additional information.

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Cite: Reference the article(https://doi.org/12345678)
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