steroids abuse and misuse and its withdrawl effects with diagnostic procedures.

1. ABUSE & MISUSE OF
STEROIDS
MADIHAAHMED
11761

2. DRUG ABUSE:
Drug or other material that are administered in a pattern and amount that interferes
with health and normal social and occupational functioning of the individual.

3. Steroids (also known as cortisone or corticosteroids) are chemicals (hormones)
that occur naturally in the body.
Steroids decrease inflammation, suppress the body's immune system, block DNA
from being made, as well as blocking a chemical called histamine (released
during an allergic reaction). Steroid medicines are man-made but are similar to
these natural hormones.
STEROIDS

4. TYPES:
There are three different types of steroids used nowadays.
– Anabolic steroid
• Are the most commonly abused steroid
• Function: To increase muscle mass and strength
– Corticosteroid
• Artificially made cortisone, cortisone is naturally produced in your body .
• Function: medically injected to reduces inflammation and injury.
– Androgenic steroid
• Has anabolic effects on bones, skeletal muscle and vocal chords.
• Function: To help treat hereditary angioedema, Behçet’s disease and aplastic
anemia

5. USE:
Commonly prescribed corticosteroid medications,
like Prednisone, Prednisolone, and
Dexamethasone are available to be taken by
mouth, intravenously, or by intramuscular
injection and may be used to treat diseases like
asthma, rheumatoid arthritis, inflammatory bowel
disease, and systemic lupus erythematosus in
which inflammation is part of the disease process.
The use of steroid ointments and creams on the
skin, like Triamcinolone and Betamethasone, is
common in the treatment of dermatitis .
STEROIDS USE AND ABUSE :

6. ABUSE:
The abuse of steroids continues to make news and
sports headlines as athletes and bodybuilders use them
illegally to gain an advantage on the playing field.
Anabolic steroids refer to hormones that are either
taken orally or by injection that influence the body's
hormonal system to produce extra testosterone. The
goal of taking anabolic steroids is to increase muscle
. Anabolic refers to this muscle-building
capability. Anabolic steroids should not be confused
with corticosteroids, which are used routinely as anti-
inflammatory medications.

7. STEROIDS WITHDRAWL FACTS :
 Synthetic cortisone medications (corticosteroids) simulate cortisol, a naturally occurring, anti-
inflammatory hormone produced by the adrenal glands. Such drugs (for example, prednisone)
have since benefited many, but are not without potential side effects.
 The two major problems related to continuous steroid treatment are:
drug side effects and symptoms due to changes in the balance of normal hormone secretion
(withdrawal symptoms).
 The production of corticosteroids is controlled by a "feedback mechanism," involving the
adrenal glands, the pituitary gland and brain. Known as the "Hypothalamic-Pituitary-Adrenal
Axis" (HPAA).
 Using large doses for a few days, or smaller doses for more than two weeks, leads to a
prolonged decrease in HPAA function.
 Steroid use cannot be stopped abruptly; tapering the drug gives the adrenal glands time to
return to their normal patterns of secretion.
 Withdrawal symptoms (weakness, fatigue, decreased appetite, weight loss, nausea, vomiting,
diarrhea, abdominal pain) can mimic many other medical problems. Some may be life-
threatening.
 Tapering may not completely prevent withdrawal symptoms. Steroid withdrawal may involve
many factors, including a true physiological dependence on corticosteroids.
 Patients should carry a list of all your medications in your wallet to alert medical personnel in
case of emergency.
 Supplementation with corticosteroid medication may be needed during periods of stress (such
as surgery), even up to a year after stopping corticosteroid therapy .

8. Steroid withdrawal symptoms can mimic
many other medical problems.
Weakness, fatigue, decreased appetite,
weight loss, nausea, vomiting, diarrhea
(which can lead to fluid and electrolyte
abnormalities), and abdominal pain are
common. Blood pressure can become too
low, leading to dizziness or fainting. Blood
sugar levels may drop. Women also may
note menstrual changes. Less often, joint
pain, muscle aches, fever, mental changes,
or elevations of calcium may be noted.
Decrease in gastrointestinal contractions can
occur, leading to dilation of the intestine
(ileus).
WITHDRAWL SYMPTOMS :

9. DIAGNOSIS :
Often steroids remain in the body for prolonged
periods of time and can be detected by urine
drug tests. It is possible that certain designer
steroid drugs may escape detection because
they are built to be less detectable.
Sometimes the steroid itself is not found but
drugs that are used as masking agents are.
Bumetanide and furosemide are diuretics, or
water pills, that may cause a false-negative test.
For professional and elite athletes, the presence
of these masking drugs in a urine sample is also
considered a failed test.
Emerging testsshow all

10. Test Result
urine toxicology testing
Should be ordered in all
patients with suspected
steroid abuse.
Exogenous androgens other
than testosterone can be
detected by gas
chromatography with mass
spectrometry.
Oral androgens can be
detected for 1 month after
administration.
Injections may be
detectable for 6 to 8
months and perhaps up to
12 months after
administration. [44]
positive for exogenous
androgens (except
testosterone)
testosterone to
epitestosterone ratio
Should be ordered in all
patients with suspected
steroid abuse.
Determines urinary ratio of
testosterone glucuronide to
epitestosterone
glucuronide.
Normally the ratio is 1 to
3:1.The World Anti-Doping
Agency considers a ratio
>4:1 to be positive for
'doping' (use of
performance-enhancing
drugs).Patients taking
exogenous testosterone will
have higher ratios (>6:1).
>6:1 in patients taking
exogenous testosterone
serum LH and FSH Should
be ordered in all patients
with suspected steroid
abuse.
Steroids inhibit production
and release of LH and FSH.
[44]
decreased
FBC Should be ordered in
all patients with suspected
steroid abuse.
Steroids stimulate
erythropoiesis and increase
platelet aggregation.
elevated RBC count,
haemoglobin, haematocrit,
WBC count, platelets
serum glucose Should be
ordered in all patients with
suspected steroid abuse.
Steroids tend to increase
serum glucose when taken
in supra-therapeutic doses.
elevated
serum electrolytes Should
be ordered in all patients
with suspected steroid
abuse.
Steroids causesodium and
water retention.
Hypernatraemia increases
rate of potassium and
hydrogen ion excretion.
Metabolic derangements
may occur (alkalosis and
compensatory respiratory
acidosis).
Electrolytes should be
obtained especially in
athletes who use diuretics.
These values are likely to be
normal in most athletes.
normal or deranged
lipid panel Should be
ordered in all patients with
suspected steroid abuse.
HDL may be decreased. LDL
may be increased.
Cholesterol may be
increased, decreased, or
normal.
These effects are
particularly observed with
orally active steroids and
areless prominent with
injectable steroids.
normal or deranged
LFTs Should be ordered in
all patients with suspected
steroid abuse.
AST or ALT maybe elevated,
indicating liver damage
(rare) or breakdown of
skeletal muscle (common).
Gamma-GT is unique to the
liver and is not present in
muscle; therefore, elevated
gamma-GT in a steroid user
should raisea genuine
concern of liver damage.It
is reported to be the most
distinctive enzyme for the
detection of hepatic
dysfunction in exercising
patients. [45]
elevated
CK Should be ordered in all
patients with suspected
steroid abuse.
Heavy exercisemay induce
muscle damageand
rhabdomyolysis in steroid
users.
normal or elevated
hepatitis serology Needle
sharing places patients at
risk of contracting
infectious diseases.
positive or negative
HIV serology Needle sharing
places patients at risk of
contracting infectious
diseases.
positive or negative
Test Result
Urine toxicology testing should be ordered in all patients with suspected steroid
abuse. Exogenous androgens other than testosterone can be detected by gas
chromatography with mass spectrometry. Oral androgens can be detected for 1
month after administration. Injections may be detectable for 6 to 8 months and
perhaps up to 12 months after administration.
positive for exogenous
androgens (except
testosterone)
Testosterone to epitestosterone ratio should be ordered in all patients with
suspected steroid abuse.Determines urinary ratio of testosterone glucuronide to
epitestosterone glucuronide. Normally the ratio is 1 to 3:1. The World Anti-
Doping Agency considers a ratio >4:1 to be positive for 'doping' (use of
performance-enhancing drugs). Patients taking exogenous testosterone will have
higher ratios (>6:1).
>6:1 in patients taking
exogenous testosterone
serum LH and FSH should be ordered in all patients with suspected steroid
abuse. Steroids inhibit production and release of LH and FSH.
Decreased
FBC should be ordered in all patients with suspected steroid abuse.
Steroids stimulate erythropoiesis and increase platelet aggregation.
elevated RBC count,
haemoglobin,
haematocrit, WBC
count, platelets
Serum glucose should be ordered in all patients with suspected steroid abuse.
Steroids tend to increase serum glucose when taken in supra-therapeutic doses.
elevated
TEST RESULT

11. serum electrolytes Should be ordered in all patients with suspected steroid abuse.
Steroids cause sodium and water retention.
Hypernatraemia increases rate of potassium and hydrogen ion excretion.
Metabolic derangements may occur (alkalosis and compensatory respiratory
acidosis).
Electrolytes should be obtained especially in athletes who use diuretics.
These values are likely to be normal in most athletes.
normal or deranged
lipid panel Should be ordered in all patients with suspected steroid abuse.
HDL may be decreased. LDL may be increased. Cholesterol may be increased, decreased, or normal.
These effects are particularly observed with orally active steroids and are less prominent with injectable steroids.
normal or deranged
LFTs Should be ordered in all patients with suspected steroid abuse.
AST or ALT may be elevated, indicating liver damage (rare) or breakdown of skeletal muscle (common).
Gamma-GT is unique to the liver and is not present in muscle; therefore, elevated gamma-GT in a steroid user should raise a
genuine concern of liver damage. It is reported to be the most distinctive enzyme for the detection of hepatic dysfunction in
exercising patients. [45]
elevated
CK Should be ordered in all patients with suspected steroid abuse.
Heavy exercise may induce muscle damage and rhabdomyolysis in steroid users.
normal or elevated
hepatitis serology Needle sharing places patients at risk of contracting infectious diseases. positive or negative
HIV serology Needle sharing places patients at risk of contracting infectious diseases. positiveor negative
Serum electrolytes should be ordered in all patients with suspected steroid abuse.
Steroids cause sodium and water retention. Hypernatraemia increases rate of potassium
and hydrogen ion excretion. Metabolic derangements may occur (alkalosis and
compensatory respiratory acidosis).Electrolytes should be obtained especially in athletes
who use diuretics. These values are likely to be normal in most athletes.
normal or
deranged
Lipid panel should be ordered in all patients with suspected steroid abuse. HDL may be
decreased. LDL may be increased. Cholesterol may be increased, decreased, or
normal.These effects are particularly observed with orally active steroids and are less
prominent with injectable steroids.
normal or
deranged
LFTs should be ordered in all patients with suspected steroid abuse. AST or ALT may be
elevated, indicating liver damage (rare) or breakdown of skeletal muscle (common).
Gamma-GT is unique to the liver and is not present in muscle; therefore, elevated
gamma-GT in a steroid user should raise a genuine concern of liver damage. It is
reported to be the most distinctive enzyme for the detection of hepatic dysfunction in
exercising patients.
elevated
CK should be ordered in all patients with suspected steroid abuse.
Heavy exercise may induce muscle damage and rhabdomyolysis in steroid users.
normal or
elevated
Hepatitis serology needle sharing places patients at risk of contracting infectious
diseases.
positive or
negative
HIV serology needle sharing places patients at risk of contracting infectious diseases.
positive or
negative
TEST RESULTS

12. Nuclear medicine cardiovascular imaging Emerging
nuclear medicine imaging modalities may improve our
ability to diagnose cardiovascular pathologies due to
androgenic anabolic steroid (AAS) use. Imaging
techniques currently being investigated include PET,
MRI, single-photon emission computed tomography
(SPECT), and echocardiography.
cardiovascular pathology
TEST RESULT
EMERGING TESTS: