Koller T, Vrbova P, Meciarova I, Molcan P, Smitka M, Adamcova Selcanova S, Skladany L. Liver injury associated with the use of selective androgen receptor modulators and post-cycle therapy: Two case reports and literature review . World J Clin Cases 2021; 9(16): 4062-4071 [PMID: 34141767 DOI: 10.12998/wjcc.v9.i16.4062]
Corresponding Author of This Article
Tomas Koller, MD, PhD, Associate Professor, Gastroenterology and Hepatology Subdiv. 5th Department of Internal Medicine, Comenius University Faculty of Medicine, Ruzinovska 6, Bratislava 82606, Slovakia. tomas.koller@fmed.uniba.sk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 6, 2021; 9(16): 4062-4071 Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4062
Liver injury associated with the use of selective androgen receptor modulators and post-cycle therapy: Two case reports and literature review
Tomas Koller, Petra Vrbova, Iveta Meciarova, Pavol Molcan, Michal Smitka, Svetlana Adamcova Selcanova, Lubomir Skladany
Tomas Koller, Petra Vrbova, Gastroenterology and Hepatology Subdiv. 5th Department of Internal Medicine, Comenius University Faculty of Medicine, University Hospital Bratislava, 82606, Slovakia
Iveta Meciarova, Department of Pathology, Alpha medical Patológia s.r.o., Bratislava 82606, Slovakia
Pavol Molcan, Svetlana Adamcova Selcanova, Lubomir Skladany, HEGITO (Division of Hepatology, Gastroenterology and Liver Transplantation), Department of Internal Medicine II of Slovak Medical University, F.D. Roosevelt University Hospital, Banska Bystrica 97517, Slovakia
Michal Smitka, Department of Pathology, FD Roosevelt Hospital, Banska Bystrica 97517, Slovakia
Author contributions: Koller T, Skladany L, and Adamcova Selcanova S were the patient´s treating physicians; Vrbova P and Molcan P drafted the manuscript; Koller T and Skladany L wrote the discussion and have approved the final text; Meciarova I and Smitka M conducted the analyses of the liver tissue.
Informed consent statement: The patients signed informed consent before any procedure and agreed with the anonymized publication of data. Our institutions do not require ethics committee approval for case reports of adverse effects of drugs or nutritional supplements.
Conflict-of-interest statement: The authors declare having no conflict of interest concerning the submitted manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist and the manuscript was prepared and revised to include all items of the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomas Koller, MD, PhD, Associate Professor, Gastroenterology and Hepatology Subdiv. 5th Department of Internal Medicine, Comenius University Faculty of Medicine, Ruzinovska 6, Bratislava 82606, Slovakia. tomas.koller@fmed.uniba.sk
Received: January 20, 2021 Peer-review started: January 20, 2021 First decision: February 24, 2021 Revised: February 28, 2021 Accepted: March 25, 2021 Article in press: March 25, 2021 Published online: June 6, 2021
Abstract
BACKGROUND
Muscle growth promoters are being developed for the treatment of disease-induced loss of muscle mass. Ligandrol and ostarine are selective androgen receptor modulators (SARMs) with a non-steroidal structure and a presumably more favorable side effect profile. In recent years, these substances with or without “post-cycle therapy” (PCT) are often misused by amateur athletes aiming to promote muscle growth. At the same time, reports on their toxic effects on organ systems are emerging.
CASE SUMMARY
We report two cases of liver injury in young men who used ligandrol and/or ostarine for a few weeks followed by the use of substances for PCT. Acute liver injury occurred in both cases after stopping SARMs while on PCT. The clinical picture was dominated by jaundice and fatigue. The biochemical pattern showed a mixed type of injury with normal alkaline phosphatase and high concentrations of bilirubin and serum bile acids. Histological evidence showed predominantly cholestatic injury with canalicular bile plugs, ductopenia, and mild hepatocellular damage without significant fibrosis. The patients recovered from the condition after 3 mo. The off target effects of SARMs were likely idiosyncratic, but our report highlights the yet unrecognized effects of other toxic substances used for PCT, supra-therapeutic doses, and the complete absence of monitoring for adverse effects.
CONCLUSION
Among muscle-building amateur athletes, SARMs (ligandrol or ostarine) and/or substances in PCT may cause cholestatic liver injury with prolonged recovery.
Core Tip: Ligandrol and ostarine are selective androgen receptor modulators with a presumably more favorable side effect profile. They are often misused by amateur body builders aiming to promote muscle growth. Reports on the toxic effects on organ systems are emerging. We report the liver injury in two young men who used ligandrol and/or ostarine in addition to other muscle-promoting substances known as post-cycle therapy. They showed jaundice and fatigue, a mixed type of injury, normal alkaline phosphatase, and high levels of bilirubin and bile acids. Histological evidence showed cholestatic injury, canalicular bile plugs, and ductopenia. The patients recovered after only 3 mo.
