Fatal anabolic androgenic steroid overdose in an amateur bodybuilder: a clinical and autopsy report.

Abstract

Stanozolol is a synthetic anabolic-androgenic steroid commonly used by bodybuilders to increase muscle mass. However, its use can lead to serious adverse effects on the liver, including cholestasis, hepatic necrosis, and even death. In this case report, we describe a fatal case of stanozolol overdose in an otherwise healthy 35-year-old amateur bodybuilder. The patient presented with general malaise, jaundice, and a history of hematemesis after taking stanozolol tablets orally for 3 months. Upon admission, his liver function tests were significantly abnormal, and he succumbed within 48 h despite symptomatic treatment. The autopsy revealed sub-massive hepatic necrosis, focal macro-vesicular steatosis, and a cholestatic pattern of acute liver injury, with the chemical examination confirming the presence of stanozolol in the blood, liver, and kidneys. The cause of death was determined to be hepatic necrosis as a complication of stanozolol overdose. The overuse of anabolic steroids like stanozolol can cause hepatotoxicity, resulting in reversible cholestatic hepatitis or, in rare cases, fatal liver injury. The mechanism of anabolic androgenic steroid (AAS) drug-induced liver injury is obscure, but proposed mechanisms include oxidative stress and cholestasis. In this case, the recent overuse of stanozolol, a 17 alpha-alkylated (oral) AAS led to sub-massive hepatic necrosis and subsequent liver failure, proving fatal. It is imperative that healthcare providers and the public are informed about the dangers of AAS use, especially since AAS usage has increased recently due to easy online access, to prevent potentially life-threatening consequences.