Multi-Organ Dysfunction in Bodybuilding Possibly Caused by Prolonged Hypercalcemia due to Multi-Substance Abuse: Case Report and Review of Literature

Abstract

A 26-year-old male bodybuilder was admitted to the surgical department of a Danish community hospital for hematemesis. During the clinical interview, he revealed that he had recently finished a course of anabolic steroids and erythropoietin. The patient also had a previous history of infections and chronic ulcers due to paraffin-oil injections in both upper arms one year before. Over the course of the next few hours, the patient developed signs of multi-organ dysfunction, including pancreatitis, hemorrhagic gastritis, nephropathy with temporary anuria, and respiratory insufficiency, and was transferred to the ICU. After manometric monitoring on the patient's upper arms proved difficult, invasive blood pressure monitoring was used and revealed that the patient was in a state of hypertensive crisis. This case of multi-organ dysfunction was possibly caused by multi-substance-induced hypercalcemia.

Key words

bodybuilding - substance abuse - site-enhancement oils - anabolic steroids - hypervitaminosis - vitamin D - vitamin A - erythropoietin - hypercalcemia - pancreatitis - nephropathy - hypertension

References

• 1 Baglin A, Hagege C, Franc B, Richaud M, Prinseau J. A systemic-like disease: chronic vitamin A poisoning.  Ann Med Interne. 1986;  137 142-146
• 2 Bhalla K, Ennis DM, Ennis ED. Hypercalcemia caused by iatrogenic hypervitaminosis A.  J Am Diet Assoc. 2005;  105 119-121
• 3 Bigi MA, Aslani A, Aslani A. Short QT interval: A novel predictor of androgen abuse in strength trained athletes.  Ann Noninvasive Electrocardiol. 2009;  14 35-39
• 4 Chatzizisis YS, Misirli G, Hatzitolios AI. Giannoglou GD The syndrome of rhabdomyolysis: complications and treatment.  Eur J Intern Med. 2008;  19 568-574
• 5 Christensson T, Hellström K, Wengle B. Clinical and laboratory findings in subjects with hypercalcaemia. A study including cases with primary hyperparathyroidism detected in a health screening.  Acta Med Scand. 1976;  200 355-360
• 6 Clark I, Smith MR. Effects of hypervitaminosis A and D on skeletal metabolism.  J Biol Chem. 1964;  239 1266-1271
• 7 Cohen EP, Trivedi C. Hypercalcaemia from non-prescription vitamin A.  Nephrol Dial Transplant. 2004;  19 2929
• 8 Cohen JC, Hickman R. Insulin resistance and diminished glucose tolerance in powerlifters ingesting anabolic steroids.  J Clin Endocrinol Metab. 1987;  64 960-963
• 9 Daher EF, Silva Júnior GB, Queiroz AL, Ramos LM, Santos SQ, Barreto DM, Guimarães AA, Barbosa CA, Franco LM, Patrocínio RM. Acute kidney injury due to anabolic steroid and vitamin supplement abuse: report of 2 cases and a literature review.  Int Urol Nephrol. 2009;  41 717-723
• 10 Darsow U, Bruckbauer H, Worret WI, Hofmann H, Ring J. Subcutaneous oleomas induced by self-injection of sesame seed oil for muscle augmentation.  J Am Acad Dermatol. 2000;  42 292-294
• 11 DeSimone DP, Reddi AH. Influence of vitamin A on matrix-induced endochondral bone formation.  Calcif Tissue Int. 1983;  35 732-739
• 12 Dicato M. Venous thromboembolic events and erythropoiesis-stimulating agents: an update.  Oncologist. 2008;  13 (S 03) 11-15
• 13 Estrada M, Espinosa A, Müller M, Jaimovich E. Testosterone stimulates intracellular calcium release and mitogen-activated protein kinases via a G protein-coupled receptor in skeletal muscle cells.  Endocrinology. 2003;  144 3586-3597
• 14 Estrada M, Liberona JL, Miranda M, Jaimovich E. Aldosterone- and testosterone-mediated intracellular calcium response in skeletal muscle cell cultures.  Am J Physiol. 2000;  279 132-139
• 15 Georgieva J, Assaf C, Steinhoff M, Treudler R, Orfanos CE, Geilen CC. Bodybuilder oleoma.  Br J Dermatol. 2003;  149 1289-1290
• 16 Häkkinen K, Alén M. Training volume, androgen use and serum creatine kinase activity.  Br J Sports Med. 1989;  23 188-189
• 17 Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes.  Sports Med. 2004;  34 513-554
• 18 Hartgens F, Rietjens G, Keizer HA, Kuipers H, Wolffenbuttel BH. Effects of androgenic-anabolic steroids on apolipoproteins and lipoprotein A.  Br J Sports Med. 2004;  38 253-259
• 19 Hartung R, Gerth J, Fünfstück R, Gröne HJ, Stein G. End-stage renal disease in a bodybuilder: a multifactorial process or simply doping?.  Nephrol Dial Transplant. 2001;  16 163-165
• 20 Henriksen TF, Løvenwald JB, Matzen SH. Paraffin oil injection in bodybuilders calls for preventive action.  Ugeskr Laeger. 2010;  172 219-220
• 21 Hilgard P. Hypercalcemia and clotting.  N Engl J Med. 1970;  283 436
• 22 Hill JA, Suker JR, Sachs K, Brigham C. The athletic polydrug abuse phenomenon. A case report.  Am J Sports Med. 1983;  11 269-271
• 23 Iversen L, Lemcke A, Bitsch M, Karlsmark T. Compression bandage as treatment for ulcers induced by intramuscular self-injection of paraffin oil.  Acta Derm Venereol. 2009;  89 196-197
• 24 Jakez-Ocampo J, Richaud-Patin Y, Llorente L. Lupus nephritis remission, albeit with positive anti-doping test.  Joint Bone Spine. 2007;  74 96-97
• 25 Karlsson MK, Hasserius R, Obrant KJ. Bone mineral density in athletes during and after career: a comparison between loaded and unloaded skeletal regions.  Calcif Tissue Int. 1996;  59 245-248
• 26 Karpati RM, Mak RH, Lemley KV. Hypercalcemia, hypertension and acute renal insufficiency in an immobilized adolescent.  Child Nephrol Urol. 1991;  11 215-219
• 27 Koopman M, Richter C, Parren RJ, Janssen M. Bodybuilding, sesame oil and vasculitis.  Rheumatology. 2005;  44 1135
• 28 Modlinski R, Fields KB. The effect of anabolic steroids on the gastrointestinal system, kidneys, and adrenal glands.  Curr Sports Med Rep. 2006;  5 104-109
• 29 Morel J, Combe B, Francisco J, Bernard J. Bone mineral density of 704 amateur sportsmen involved in different physical activities.  Osteoporos Int. 2001;  12 152-157
• 30 Mulkey LE. Renal infarction, elevated transaminases, and renal insufficiency after an acute bout of abdominal pain in a bodybuilder.  Clin J Sport Med. 2007;  17 326-327
• 31 Munch IC, Hvolris JJ. Body building aided by intramuscular injections of walnut oil.  Ugeskr Laeger. 2001;  163 6758
• 32 Pärssinen M, Kujala U, Vartiainen E, Sarna S, Seppälä T. Increased premature mortality of competitive powerlifters suspected to have used anabolic agents.  Int J Sports Med. 2000;  21 225-227
• 33 Pertusi R, Dickerman RD, McConathy WJ. Evaluation of aminotransferase elevations in a bodybuilder using anabolic steroids: hepatitis or rhabdomyolysis?.  J Am Osteopath Assoc. 2001;  101 391-394
• 34 Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE. The athlete's heart. A meta-analysis of cardiac structure and function.  Circulation. 2000;  101 336-344
• 35 Ravelli AM. Gastrointestinal function in chronic renal failure.  Pediatr Nephrol. 1995;  9 756-762
• 36 Sader MA, Griffiths KA, McCredie RJ, Handelsman DJ, Celermajer DS. Androgenic anabolic steroids and arterial structure and function in male bodybuilders.  J Am Coll Cardiol. 2001;  37 224-230
• 37 Samaha AA, Nasser-Eddine W, Shatila E, Haddad JJ, Wazne J, Eid AH. Multi-organ damage induced by anabolic steroid supplements: a case report and literature review.  J Med Case Reports. 2008;  2 340
• 38 Sandhu RS, Como JJ, Scalea TS, Betts JM. Renal failure and exercise-induced rhabdomyolysis in patients taking performance-enhancing compounds.  J Trauma. 2002;  53 761-763
• 39 Shahidi NT. A review of the chemistry, biological action, and clinical applications of anabolic-androgenic steroids.  Clin Ther. 2001;  23 1355-1390
• 40 Thorsteinsdottir B, Grande JP, Garovic VD. Acute renal failure in a young weight lifter taking multiple food supplements, including creatine monohydrate.  J Ren Nutr. 2006;  16 341-345
• 41 Titan SM, Callas SH, Uip DE, Kalil-Filho R, A Galvão PC. Acute renal failure and hypercalcemia in an athletic young man.  Clin Nephrol. 2009;  71 445-447
• 42 Urhausen A, Torsten A, Wilfried K. Reversibility of the effects on blood cells, lipids, liver function and hormones in former anabolic-androgenic steroid abusers.  J Steroid Biochem Mol Biol. 2003;  84 369-375

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