The adverse health consequences of the use of multiple performance-enhancing substances--a deadly cocktail.
BACKGROUND
The harmful consequences of abuse of performance-enhancing substances (PESs), stimulants, and masking agents among athletes, recreational weight lifters, and physical trainers are common. However, the adverse health outcomes with severe unexpected and dramatic consequences are unrecognized or under-reported at the expense of short-term glory or body-image effects, especially in elite sports.


OBJECTIVE
We report the case of a recreational weight lifter/physical trainer to help summarize the adverse health consequences and outcomes of polypharmacy among athletes and growing subsets in our population engaged in physical/fitness training. We show that in addition to the risk inherent to "stacking" of PESs, the users are predisposed to harmful consequences, including risk of exposure to toxic contaminants.


METHODS
A previously healthy man with chronic use of multiple PESs, stimulants, and masking agents presented to a tertiary-care hospital with jaundice and mild hepatitis with rapid progression into liver and multisystem organ failure. This is followed by a brief overview of the specific toxicity (arsenic) and PESs that contributed to the poor outcome in this case.


CONCLUSIONS
Surreptitiously or self-administered cocktails of potential PESs including anabolic agents, emerging classes of GH-releasing peptides, androgen precursors, stimulants, and masking agents could lead to adverse consequences including early mortality, multisystem pathology, unmask/accelerate malignancy, and expose or predispose users to extreme danger from contaminants. This cautionary case reinforces the need to increase awareness and highlights the challenges that testing agencies, regulators, and clinicians face in the fast-developing licit/illicit trade of these products.
Department of Endocrinology, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia. nimalie.perera@email.cs.nsw.gov.au.
Nimalie J
NJ
Perera
Katherine S
KS
Steinbeck
Nicholas
N
Shackel
D000328:Adult; D020261:Arsenic Poisoning / Q000209:etiology / Q000503:physiopathology; D056352:Athletes; D056486:Chemical and Drug Induced Liver Injury / Q000503:physiopathology; D019587:Dietary Supplements / Q000009:adverse effects*; D018450:Disease Progression; D004340:Drug Contamination; D004347:Drug Interactions; D017809:Fatal Outcome; D006801:Humans; D007565:Jaundice / Q000209:etiology; D017093:Liver Failure / Q000209:etiology; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D009517:New South Wales; D004366:Nonprescription Drugs / Q000009:adverse effects*; D058573:Performance-Enhancing Substances / Q000009:adverse effects*; D019338:Polypharmacy; D014891:Weight Lifting
D004366:Nonprescription Drugs; D058573:Performance-Enhancing Substances