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Can steroids cause damage to nervous system by depletion of Vitamins?
We report a case of a 33-year-old male bodybuilder patient who was admitted to the emergency department with acute gastrointestinal bleeding (hematemesis and hematochezia) after intense vomiting. He had been drinking alcoholic beverages the night before. Urgent endoscopy revealed a Mallory-Weiss syndrome (laceration of the gastroesophageal junction lining caused by the severe vomiting) which was treated with local ethanolamine application. The bleeding relapsed twelve hours later and he was admitted to the Intensive Care Unit (ICU) with hypovolemic shock. With rapidly deteriorating mental status, profound anemia and metabolic acidosis he was intubated and mechanically ventilated. Further management comprised of endoscopic ligation with clips and ablation of the bleeding lesion, while the hypovolemic shock was resolved after abundant whole blood, fresh frozen plasma, platelet and crystalloid/colloid transfusion. His situation was further complicated with rhabdomyolysis in need of continuous renal replacement therapy. During his stay in the ICU, he was under standard total parenteral nutrition (TPN), according to his caloric requirements (standard thiamine supplementation 3,5 mg/day).
Two weeks later he was stabilized, but during weaning from the ventilator, he showed impaired mental status [global confusional state with a Glasgow Coma Scale (GCS) 13/15], ophthalmoplegia (bilateral abducent nerve palsy), nystagmus, clonus and increased deep tendon reflexes of the lower extremities. A diagnosis of encephalopathy was suspected, with Wernicke's being the most probable, so he underwent an MRI scanning; nevertheless, apart from some generalized atrophy, this was not indicative for the specific or any other encephalopathy. A thorough clinical history review revealed anabolic steroid drug abuse for the last 12 months, including testosterone analogues (Winstral®, Anavar®, Trenbolone®), human growth hormone and insuline. A thiamine supplementation regimen was started immediately (Neurobion®, B-complex vitamin therapy containing 100 mg thiamine) intramuscular injection every 8 hours for five days, followed by oral intake for the next seven days.
Four days after treatment initiation he was successfully extubated having fully restored mental state
Discuss.
Can steroids possibly cause damage to the nervous system or deplete such valuable Vitamins such as Thiamine? I know generally stimulants and alcohol deplete this critical B vitamin. My use of amphetamines in the past damaged me severely and I was on anabolics at the same time.
We report a case of a 33-year-old male bodybuilder patient who was admitted to the emergency department with acute gastrointestinal bleeding (hematemesis and hematochezia) after intense vomiting. He had been drinking alcoholic beverages the night before. Urgent endoscopy revealed a Mallory-Weiss syndrome (laceration of the gastroesophageal junction lining caused by the severe vomiting) which was treated with local ethanolamine application. The bleeding relapsed twelve hours later and he was admitted to the Intensive Care Unit (ICU) with hypovolemic shock. With rapidly deteriorating mental status, profound anemia and metabolic acidosis he was intubated and mechanically ventilated. Further management comprised of endoscopic ligation with clips and ablation of the bleeding lesion, while the hypovolemic shock was resolved after abundant whole blood, fresh frozen plasma, platelet and crystalloid/colloid transfusion. His situation was further complicated with rhabdomyolysis in need of continuous renal replacement therapy. During his stay in the ICU, he was under standard total parenteral nutrition (TPN), according to his caloric requirements (standard thiamine supplementation 3,5 mg/day).
Two weeks later he was stabilized, but during weaning from the ventilator, he showed impaired mental status [global confusional state with a Glasgow Coma Scale (GCS) 13/15], ophthalmoplegia (bilateral abducent nerve palsy), nystagmus, clonus and increased deep tendon reflexes of the lower extremities. A diagnosis of encephalopathy was suspected, with Wernicke's being the most probable, so he underwent an MRI scanning; nevertheless, apart from some generalized atrophy, this was not indicative for the specific or any other encephalopathy. A thorough clinical history review revealed anabolic steroid drug abuse for the last 12 months, including testosterone analogues (Winstral®, Anavar®, Trenbolone®), human growth hormone and insuline. A thiamine supplementation regimen was started immediately (Neurobion®, B-complex vitamin therapy containing 100 mg thiamine) intramuscular injection every 8 hours for five days, followed by oral intake for the next seven days.
Four days after treatment initiation he was successfully extubated having fully restored mental state
"Wernicke's encephalopathy is associated with thiamine deficiency and may rise in many clinical settings like cancer, hyperemesis gravidarum, gastric bypass and other bariatric operations, quite often due to iatrogenic conditions (use of drugs) and malnutrition of any reason, such as alcohol abuse or prolonged starvation2,3. The clinical interest of the reported case is attributed to the existence of a combination of various predisposing factors which could be responsible for the syndrome.
The etiological factor in the presented case might be the patient's history of anabolic steroid drug abuse for 12 months before his admission, and the acute withdrawal which triggered the manifestation of the syndrome. It is well established in the literature, that function of multiple systems in human body is impaired in case of abuse of these pharmacologic agents. Apart from the damage cased in organs like liver, heart, lungs and kidneys, anabolics are proved to be extremely toxic for the central nervous system (CNS). In many cases this toxicity against CNS cells is irreversible, especially if the abuse is chronic.
Known anabolic steroids that can cause encephalopathy are methandrostenolone and nandrolone. Acute withdrawal of drugs with anabolic effects (such as gamma-hydroxyburate), can cause encephalopathy with symptoms that mimic Wernicke's encephalopathy5. A literature search failed to prove direct connection between the specific anabolics used by our patient and withdrawal syndrome, but both excessive use and sudden withdrawal from these agents could not be excluded as a possible predisposing factor. In addition, a detailed and focused history as reported by the patient and his family, revealed the patient's specific dietary habits for gain weight and muscle augmentation along with neglect of foods, sources of thiamine.
He refused alcohol addiction. We did not find any other common cause for his clinical condition. Liver function was normal and no other diseases related with the syndrome such as HIV or malabsorption, were diagnosed2."
The etiological factor in the presented case might be the patient's history of anabolic steroid drug abuse for 12 months before his admission, and the acute withdrawal which triggered the manifestation of the syndrome. It is well established in the literature, that function of multiple systems in human body is impaired in case of abuse of these pharmacologic agents. Apart from the damage cased in organs like liver, heart, lungs and kidneys, anabolics are proved to be extremely toxic for the central nervous system (CNS). In many cases this toxicity against CNS cells is irreversible, especially if the abuse is chronic.
Known anabolic steroids that can cause encephalopathy are methandrostenolone and nandrolone. Acute withdrawal of drugs with anabolic effects (such as gamma-hydroxyburate), can cause encephalopathy with symptoms that mimic Wernicke's encephalopathy5. A literature search failed to prove direct connection between the specific anabolics used by our patient and withdrawal syndrome, but both excessive use and sudden withdrawal from these agents could not be excluded as a possible predisposing factor. In addition, a detailed and focused history as reported by the patient and his family, revealed the patient's specific dietary habits for gain weight and muscle augmentation along with neglect of foods, sources of thiamine.
He refused alcohol addiction. We did not find any other common cause for his clinical condition. Liver function was normal and no other diseases related with the syndrome such as HIV or malabsorption, were diagnosed2."
Can steroids possibly cause damage to the nervous system or deplete such valuable Vitamins such as Thiamine? I know generally stimulants and alcohol deplete this critical B vitamin. My use of amphetamines in the past damaged me severely and I was on anabolics at the same time.
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