E-ISSN 2146-8362 |
 

Case Report Open Access


Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase

Savvoula Savvidou, Asterios Gagalis, Ioannis Efstratiou, Athanasios Kalambakas.

Abstract
The indisputable hepatotoxicity of anabolic androgen steroids has already been well substantiated in the literature, eventhough the exact pathophysiologic mechanisms are still being elucidated. Androgen-induced liver injury presents primarily with acute intrahepatic cholestasis accompanied by markedly elevated cholestatic enzymes and diverse levels of aminotransferases.
A case report of a young male with remarkable jaundice due to acute anabolic androgen-induced cholestasis is presented. Interestingly, γ-glutamyl transpeptidase remained normal throughout the patients diagnostic workup. Histopathology was indicative of pure, bland intrahepatic cholestasis with minimal inflammation but significant fibrosis. The patient was successfully treated with ursodeoxycholic acid and glucocorticosteroids. The significance of normal γ-glutamyl transpeptidase along with the histopathological findings and the possible pathophysiological mechanisms are finally discussed.

Key words: anabolics; androgens; drug-induced liver injury; cholestasis; γ-glutamyl transpeptidase


 
ARTICLE TOOLS
Abstract
PDF Fulltext
Print this article Print this Article
How to cite this articleHow to cite this article
Export to
Export to
Related Records
 Articles by Savvoula Savvidou
Articles by Asterios Gagalis
Articles by Ioannis Efstratiou
Articles by Athanasios Kalambakas
on Google
on Google Scholar
Article Statistics
 Viewed: 1345
Downloaded: 398
Cited: 0

REFERENCES
1. Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med 2013; 173(15):1465-1466. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]   
2. Pope HG Jr, Kanayama G, Athey A, Ryan E, Hudson JI, Baggish A. The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: Current best estimates. Am J Addict 2013; [DOI via Crossref]    [DOI via Crossref]   
3. Handelsman DJ. Global trends in testosterone prescribing, 2000-2011: expanding the spectrum of prescription drug misuse. Med J Aust 2013; 199(8):548-551. [DOI via Crossref]    [Pubmed]   
4. Chazouilleres O, Housset C. Intrahepatic cholestasis. In: Rodes J, Benhamou JP, Blei A, Reichen J, Rizzetto M (eds) The Textbook of Hepatology: From Basic Science To Clinical Practice, Volume 2, 3rd edition, Wiley-Blackwell Publishing, UK, pp1481-1500, 2007.
5. Sánchez-Osorio M, Duarte-Rojo A, Martínez-Benítez B, Torre A, Uribe M. Anabolic-androgenic steroids and liver injury. Liver Int 2008; 28(2):278-282. [DOI via Crossref]    [Pubmed]   
6. Soe KL, Soe M, Gluud C. Liver pathology associated with the use of anabolic-androgenic steroids. Liver 1992; 12:73-79 [DOI via Crossref]    [Pubmed]   
7. Ishak G, Zimmerman HJ. Hepatotoxic effects of the anabolic/androgenic steroids. Semin Liver Dis 1987; 7:230-236. [DOI via Crossref]    [Pubmed]   
8. Etogo-Asse F, Boemer F, Sempoux C, Geubel A. Acute hepatitis with prolonged cholestasis and disappearance of interlobular bile ducts following tibolone and Hypericumperforatum (St. John's wort). Case of drug interaction? ActaGastroenterolBelg 2008; 71(1):36-38.
9. Tsirigotis P, Sella T, Shapira MY, Bitan M, Bloom A, Kiselgoff D, Levin M, Libster D, Abdul Hai A, Gesundheit B, Or R, Slavin S, Resnick I. Peliosishepatis following treatment with androgen-steroids in patients with bone marrow failure syndromes. Haematologica 2007; 92(11):e106-110.
10. Martin NM, Abu Dayyeh BK, Chung RT. Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage. World J Gastroenterol 2008; 14(28): 4573-4575. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]   
11. Socas L, Zumbado M, Perez-Luzardo O, Ramos A, Perez C, Hernandez JR, Boada LD. Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature. Br J Sports Med 2005; 39: e27.
12. Pais-Costa SR, Lima OA, Soares AF. Giant hepatic adenoma associated with anabolic-androgenic steroid abuse: case report. Arq Bras Cir Dig 2012; 25(3):180-182. [DOI via Crossref]    [Pubmed]   
13. Gorayski P, Thompson CH, Subhash HS, Thomas AC. Hepatocellular carcinoma associated with recreational anabolic steroid use. Br J Sports Med 2008; 42:74-75. [DOI via Crossref]    [Pubmed]   
14. Kullak-Ublick GA, Stieger B, Hagenbuch B, Meier PJ. Hepatic transport of bile salts. Semin Liver Dis 2000; 20(3):273-292. [DOI via Crossref]    [Pubmed]   
15. Goldberg DM. Structural, functional, and clinical aspects of gamma-glutamyltransferase. CRC Crit Rev Clin Lab Sci 1980; 12:1â€"58.
16. Whitfield JB. Gamma glutamyltransferase. Crit Rev Clin Lab Sci 2001; 38:263â€"355.
17. Giannattasio A, D’Ambrossi M, Volpicelli M, Iorio R. Steroid therapy for a case of severe drug-induced cholestasis. Ann Pharmacother 2006; 40(6):1196-1199. [DOI via Crossref]    [Pubmed]   
18. Wree A, Dechêne A, Herzer K, Hilgard P, Syn WK, Gerken G, Canbay A. Steroid and ursodesoxycholic Acid combination therapy in severe drug-induced liver injury. Digestion 2011; 84(1):54-59. [DOI via Crossref]    [Pubmed]   

How to Cite this Article
Pubmed Style

Savvidou S, Gagalis A, Efstratiou I, Kalambakas A. Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase. J Interdiscipl Histopathol. 2014; 2(2): 98-103. doi:10.5455/jihp.20140305101625


Web Style

Savvidou S, Gagalis A, Efstratiou I, Kalambakas A. Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase. http://www.jidhp.com/?mno=151669 [Access: January 23, 2018]. doi:10.5455/jihp.20140305101625


AMA (American Medical Association) Style

Savvidou S, Gagalis A, Efstratiou I, Kalambakas A. Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase. J Interdiscipl Histopathol. 2014; 2(2): 98-103. doi:10.5455/jihp.20140305101625



Vancouver/ICMJE Style

Savvidou S, Gagalis A, Efstratiou I, Kalambakas A. Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase. J Interdiscipl Histopathol. (2014), [cited January 23, 2018]; 2(2): 98-103. doi:10.5455/jihp.20140305101625



Harvard Style

Savvidou, S., Gagalis, A., Efstratiou, I. & Kalambakas, A. (2014) Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase. J Interdiscipl Histopathol, 2 (2), 98-103. doi:10.5455/jihp.20140305101625



Turabian Style

Savvidou, Savvoula, Asterios Gagalis, Ioannis Efstratiou, and Athanasios Kalambakas. 2014. Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase. Journal of Interdisciplinary Histopathology, 2 (2), 98-103. doi:10.5455/jihp.20140305101625



Chicago Style

Savvidou, Savvoula, Asterios Gagalis, Ioannis Efstratiou, and Athanasios Kalambakas. "Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase." Journal of Interdisciplinary Histopathology 2 (2014), 98-103. doi:10.5455/jihp.20140305101625



MLA (The Modern Language Association) Style

Savvidou, Savvoula, Asterios Gagalis, Ioannis Efstratiou, and Athanasios Kalambakas. "Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase." Journal of Interdisciplinary Histopathology 2.2 (2014), 98-103. Print. doi:10.5455/jihp.20140305101625



APA (American Psychological Association) Style

Savvidou, S., Gagalis, A., Efstratiou, I. & Kalambakas, A. (2014) Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase. Journal of Interdisciplinary Histopathology, 2 (2), 98-103. doi:10.5455/jihp.20140305101625





Most Viewed Articles
  • Prevalence of Anemia and Associated Risk Factors among Pregnant Women Attending Antenatal Care in Azezo Health Center Gondar Town, Northwest Ethiopia
    Meseret Alem, Bamlaku Enawgaw, Aschalew Gelaw, Tigist Kenaw, Mohamed Seid , Yadesa Olkeba
    J Interdiscipl Histopathol. 2013; 1(3): 137-144
    » Abstract & References » doi: 10.5455/jihp.20130122042052

  • Cytomorphometric Analysis of Oral Premalignant and Malignant Lesions Using Feulgen Stain and Exfoliative Brush Cytology.
    Priya Shirish Joshi, Manasi Sandipak Kaijkar
    J Interdiscipl Histopathol. 2013; 1(4): 204-211
    » Abstract & References » doi: 10.5455/jihp.20130214064844

  • The Role of CD10 Immunohistochemistry in the Grading of Phyllodes Tumour of The Breast
    Huzlinda Hussin,Jayalakshmi Pailoor, Peh Suat Cheng
    J Interdiscipl Histopathol. 2013; 1(4): 195-203
    » Abstract & References » doi: 10.5455/jihp.20130307011432

  • Differences in the Angiogenesis of Benign and Malignant Surface Epithelial Ovarian Tumors Demonstrated by Microvessel Density and Immunohistochemistry
    Shelly Sehgal, Prashant Goyal, Reena Agarwal, Sompal Singh, Awanindra Kumar, Ruchika Gupta, Vinita Kumar, Dipti Agrawal
    J Interdiscipl Histopathol. 2013; 1(3): 145-152
    » Abstract & References » doi: 10.5455/jihp.20130204114930

  • Retroperitoneal Non-functioning Paraganglioma: A Case Report
    Faten Limaiem, Saadia Bouraoui, Sirine Bouslama, Sana Ben Slama, Ahlem Lahmar, Sabeh Mzabi-Regaya
    J Interdiscipl Histopathol. 2013; 1(3): 168-171
    » Abstract & References » doi: 10.5455/jihp.20130115114630

  • Nonspecific Cecal Ulcer: An Obsolete Jargon
    Duvuru Ram, Vilvapathy Senguttuvan Karthikeyan, Sarath Chandra Sistla
    J Interdiscipl Histopathol. 2013; 1(2): 85-88
    » Abstract & References » doi: 10.5455/jihp.20121228043742

  • P53 Immunohistochemical Staining Patterns in Benign, Premalignant and Malignant Lesions of the Oral Cavity: A Study of 68 Cases
    Pankaj Baweja, Vidya Monappa, Geetha Krishnanand
    J Interdiscipl Histopathol. 2013; 1(3): 113-120
    » Abstract & References » doi: 10.5455/jihp.20130121120725

  • Histopathology as diagnostic tool for Ascosphaera apis infection in apparently healthy honey bees (Apis mellifera ligustica)
    Paola Maiolino, Francesca Carella, Giovanna De Leva, Laura Rinaldi, Giuseppe Cringoli, Manuela Martano
    J Interdiscipl Histopathol. 2013; 1(3): 160-162
    » Abstract & References » doi: 10.5455/jihp.20130128010436

  • Double-Hit Lymphoma Presenting as Primary Renal Lymphoma: A Case Report
    Vikas Mehta, Chad Ellimottil, Jodi Speiser, Milind Velankar, Guliz A Barkan
    J Interdiscipl Histopathol. 2013; 1(2): 93-97
    » Abstract & References » doi: 10.5455/jihp.20130121075815

  • Lateral Periodontal Cyst: A Report of Two Cases with Varying Clinico-Radiological Features
    Preethi Balan, Subhas G Babu, Shishir Shetty, Deepa Dsouza
    J Interdiscipl Histopathol. 2012; 1(1): 41-44
    » Abstract & References » doi: 10.5455/jihp.20120808010902

  • Most Downloaded
  • Prevalence of Anemia and Associated Risk Factors among Pregnant Women Attending Antenatal Care in Azezo Health Center Gondar Town, Northwest Ethiopia
    Meseret Alem, Bamlaku Enawgaw, Aschalew Gelaw, Tigist Kenaw, Mohamed Seid , Yadesa Olkeba
    J Interdiscipl Histopathol. 2013; 1(3): 137-144
    » Abstract & References » doi: 10.5455/jihp.20130122042052

  • Cytomorphometric Analysis of Oral Premalignant and Malignant Lesions Using Feulgen Stain and Exfoliative Brush Cytology.
    Priya Shirish Joshi, Manasi Sandipak Kaijkar
    J Interdiscipl Histopathol. 2013; 1(4): 204-211
    » Abstract & References » doi: 10.5455/jihp.20130214064844

  • P53 Immunohistochemical Staining Patterns in Benign, Premalignant and Malignant Lesions of the Oral Cavity: A Study of 68 Cases
    Pankaj Baweja, Vidya Monappa, Geetha Krishnanand
    J Interdiscipl Histopathol. 2013; 1(3): 113-120
    » Abstract & References » doi: 10.5455/jihp.20130121120725

  • Small Cell Lung Carcinoma: Better Than Its Reputation? A Population Based Study
    Hans Rostad, Erik Heyerdahl Strom, Helge Scott, Maria Ramnefjell, Kjell Kjellevold
    J Interdiscipl Histopathol. 2012; 1(1): 1-4
    » Abstract & References » doi: 10.5455/jihp.20120703032839

  • Histopathology of the Liver Following Administration of Artesunate in Adult Wistar Rats
    Felix Monday Onyije, Josiah S Hart
    J Interdiscipl Histopathol. 2012; 1(1): 26-29
    » Abstract & References » doi: 10.5455/jihp.20120606081137

  • Lateral Periodontal Cyst: A Report of Two Cases with Varying Clinico-Radiological Features
    Preethi Balan, Subhas G Babu, Shishir Shetty, Deepa Dsouza
    J Interdiscipl Histopathol. 2012; 1(1): 41-44
    » Abstract & References » doi: 10.5455/jihp.20120808010902

  • Stented Vessels: A Challenge for Histological Preparation and Microscopy
    Andrea Nolte, Theresa Braun, Sven Zur Oven Krockhaus, Adelheid Munz, Ulrich Vogel, Christian Schlensak, Hans Wendel, Tobias Walker
    J Interdiscipl Histopathol. 2013; 1(3): 104-112
    » Abstract & References » doi: 10.5455/jihp.20130306112937

  • Role of HPV Vaccine in the Prevention of Cervical Cancer
    Saleh JA, Yusuph H, Zailani ZB
    J Interdiscipl Histopathol. 2013; 1(4): 212-216
    » Abstract & References » doi: 10.5455/jihp.20130119122700

  • The Role of CD10 Immunohistochemistry in the Grading of Phyllodes Tumour of The Breast
    Huzlinda Hussin,Jayalakshmi Pailoor, Peh Suat Cheng
    J Interdiscipl Histopathol. 2013; 1(4): 195-203
    » Abstract & References » doi: 10.5455/jihp.20130307011432

  • Histopathological Effects of Varied Fluoride Concentration on Cerebrum in Albino Rats
    Sajad Hamid, Zaffar Kawoosa, Shahnawaz Hamid, M.A. Mir, Athar Hafiz, Irfan Jan, Fayiza Yaqoob
    J Interdiscipl Histopathol. 2012; 1(1): 30-34
    » Abstract & References » doi: 10.5455/jihp.20121105123701

  • Most Cited Articles
  • Prevalence of Anemia and Associated Risk Factors among Pregnant Women Attending Antenatal Care in Azezo Health Center Gondar Town, Northwest Ethiopia
    Meseret Alem, Bamlaku Enawgaw, Aschalew Gelaw, Tigist Kenaw, Mohamed Seid , Yadesa Olkeba
    J Interdiscipl Histopathol. 2013; 1(3): 137-144
    » Abstract & References » doi: 10.5455/jihp.20130122042052
    Cited : 15 times [Click to see citing articles]

  • Renal Biopsy for Research: An Overview of Russian Experience
    Sergei V. Jargin
    J Interdiscipl Histopathol. 2014; 2(2): 88-95
    » Abstract & References » doi: 10.5455/jihp.20140312020838
    Cited : 4 times [Click to see citing articles]

  • The Senescence Process of Internal Thoracic Artery
    Antonio Manenti, Luca Roncati, Giuseppe Barbolini, Francesco Rivasi
    J Interdiscipl Histopathol. 2013; 1(2): 58-61
    » Abstract & References » doi: 10.5455/jihp.20121211115233
    Cited : 3 times [Click to see citing articles]

  • Primary Biliary Cirrhosis Overlapping with Autoimmune Hepatitis in an HIV-Infected Patient on Antiretroviral Therapy
    Margaret Rae Caplan, Apurva Trivedi, Mary McLaughlin, Annick Hebou, David Kleiner, Theo Heller, Caryn Morse
    J Interdiscipl Histopathol. 2013; 1(5): 270-273
    » Abstract & References » doi: 10.5455/jihp.20130624104921
    Cited : 3 times [Click to see citing articles]

  • Evaluation of Amelotin Expression in Benign Odontogenic Tumors
    Daiana Paula Stolf, Tae-Young Lee, Grace Bradley, Bernhard Ganss
    J Interdiscipl Histopathol. 2013; 1(5): 236-245
    » Abstract & References » doi: 10.5455/jihp.20130506045106
    Cited : 2 times [Click to see citing articles]

  • Diffuse Cutaneous Leishmaniasis in an HIV Sero-Positive Patient - A Diagnostic Dilemma
    Kumar U Mahesh, Balasaheb Ramling Yelikar, Ratnakar Madhav Rao Potekar, Palin Aparna, Murthy Keshav
    J Interdiscipl Histopathol. 2012; 1(1): 45-47
    » Abstract & References » doi: 10.5455/jihp.20121109060828
    Cited : 2 times [Click to see citing articles]

  • Small Cell Lung Carcinoma: Better Than Its Reputation? A Population Based Study
    Hans Rostad, Erik Heyerdahl Strom, Helge Scott, Maria Ramnefjell, Kjell Kjellevold
    J Interdiscipl Histopathol. 2012; 1(1): 1-4
    » Abstract & References » doi: 10.5455/jihp.20120703032839
    Cited : 2 times [Click to see citing articles]

  • Association of Claudin-1 with E-Cadherin/Catenin Complex, Microvessel Density (MVD)-Related Markers, and Clinicopathological Features in Colorectal Carcinoma
    Urania Skoufi, Dimitrios L Arvanitis, Litsa Lampri, Elli Ioachim, Jim Koutsogiannis, Christina Skoufi, Dimitris Tsironis and Antigony Mitselou
    J Interdiscipl Histopathol. 2014; 2(3): 135-144
    » Abstract & References » doi: 10.5455/jihp.20140429121735
    Cited : 2 times [Click to see citing articles]

  • Cadmium-Induced Testicular Toxicity, Oxidative Stress and Histopathology in Wistar Rats: Sustained Effects of Polyphenol-Rich Extract of Vernonia Amygdalina (Del.) Leaf
    Christian Eseigbe Imafidon, Olatoye Taiwo Risikat, Bamidele Funminiyi Samuel, Ojo Opeyemi Esther, Ademoye Kehinde Aderonke
    J Interdiscipl Histopathol. 2016; 4(3): 54-62
    » Abstract & References » doi: 10.5455/jihp.20160618041629
    Cited : 2 times [Click to see citing articles]

  • Histopathological Effects of Varied Fluoride Concentration on Cerebrum in Albino Rats
    Sajad Hamid, Zaffar Kawoosa, Shahnawaz Hamid, M.A. Mir, Athar Hafiz, Irfan Jan, Fayiza Yaqoob
    J Interdiscipl Histopathol. 2012; 1(1): 30-34
    » Abstract & References » doi: 10.5455/jihp.20121105123701
    Cited : 2 times [Click to see citing articles]