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Massachusetts Medical Care | Lahey Hospital & Medical Center
Performance-enhancing drugs PEDs are commonly consumed in the United States with high prevalence of use in athlete populations and increased use by deployed service members. Many PEDs may contain anabolic-androgenic steroids AAS , which are legally restricted and prohibited by many agencies due to their health risk.
The patient is a healthy year-old male Marine who presented with multiple episodes of abdominal cramps each day for a month with decreased appetite and nonbilious vomiting. Increased awareness of significant PED-associated adverse effects by both the civilian and military communities is needed to better characterize these risks moving forward.
The dietary supplement market to include performance-enhancing drugs PEDs has been on a continuous rise in recent decades with global sales reaching tens of billions of dollars annually. Many commercially available PEDs, including but not limited to designer steroids or prohormones, have been found to contain anabolic-androgenic steroids AAS 5 not identified on product labeling.
In the unregulated PED commercial market, adulterated or even false labeling generates unmitigated health risk for product consumers. Their latest list was rendered effective since January 1, Reported side effects from AAS include changes in libido, muscle spasms, gynecomastia, and increased aggressiveness.
We highlight acute pancreatitis as an important adverse effect from widely available, increasingly regulated agents contained in the supplement, mainly designer steroids. We present an otherwise healthy year-old male active duty service member who began experiencing 6 to 7 episodes of abdominal cramps per day for about a month.
He also reported a lb weight loss over the month due to decreased appetite. He denied fever, chills, night sweats, pyrosis, hematochezia, diarrhea, or constipation. Review of systems revealed nonbloody, nonbilious vomiting and fatigue. The service member recalls a single bout of alcohol use, drinking 8 to 9 beers, a full month before presentation. He reports sexual activity with multiple sexual partners. He reports stopping all supplements once episodes of abdominal pain started.
Vital signs on presentation were within normal limits. Examination revealed a well-developed young adult male with normal muscular build. He exhibited mild tenderness on palpation of the left upper and lower quadrants with a negative Murphy's sign.
No evidence of jaundice was present. Urinalysis was bland and urine drug screen without toxins. A right upper quadrant ultrasound revealed normal hepatic echogenicity and echotexture without intra- or extrahepatic biliary duct dilatation; the common bile duct measured was 0.
The gallbladder was normal without stones or pericholecystic fluid. The pancreas appeared hypoechoic and computed tomography scan of his abdomen showed an enlarged pancreas, at the body and tail, with surrounding inflammatory stranding.
During his 5-day admission, his pain improved with intravenous fluid resuscitation, tramadol, and pancreatic rest. His diet was slowly advanced without complication or abdominal pain recurrence and he was discharged to home. He remained healthy at 6 weeks postdischarge with clinical diagnosis of PED-associated pancreatitis.
The service member did not provide the supplement for quantitative analysis. The clinical time line and ethanol exposure lowers suspicion for alcohol-induced pancreatitis. Importantly, this case demonstrated no other hepatobiliary disease process. Additionally, reports of unlabeled contaminants further contribute to the unmitigated risk with use of these products. Hence, the potential for adverse effects with supplement use should prompt clinicians to adopt effective screening strategies for supplement use in at-risk populations.
Because PEDs are marketed to U. In response to this report, the Department of Defense initiative called Operation Supplement Safety http: As more about the risks associated with PED use is understood, emerging screening strategies need to be evaluated and considered for high-risk populations. Due to the frequency of product adulteration, 16 pathophysiologic mechanisms cannot be elucidated or determined without quantitative analysis of PEDs and other supplements.
Educating clinicians to further the science through supplement analysis may have an important role in advancing the science, and addressing the risk for future warfighters and athletes. We thank our colleagues from the Consortium of Health and Military Performance who provided insight and expertise that greatly assisted the case report and improved the manuscript.
Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Close mobile search navigation Article navigation. Guerilla Warfare on the Pancreas?
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