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Hepatotoxicity from anabolic androgenic steroids marketed as dietary supplements: contribution from ATP8B1/ABCB11 mutations?
[benign recurrent intrahepatic cholestasis]
Though
possession
of
androgenic
anabolic
steroids
(
AAS
)
is
illegal
,
non-prescription
use
of
AAS
persists
.
We
describe
two
Caucasian
males
(
aged
25
and
45
years
)
with
cholestatic
hepatitis
following
ingestion
of
the
dietary
supplement
Mass-
Drol
(
'
Celtic
Dragon
'
)
containing
the
AAS
2
α-
17
α-dimethyl-etiocholan-
3
-
one
,
17
β-ol
.
D
espite
substantial
hyperbilirubinaemia
peak
gamma-glutamyl
transferase
(
GGT
)
remained
normal
.
Besides
'
bland
'
intralobular
cholestasis
,
liver
biopsy
in
both
found
deficiency
of
canalicular
expression
of
ectoenzymes
as
seen
in
ATP
8
B
1
disease
.
In
the
older
patient
,
bile
salt
export
pump
marking
(
encoded
by
ABCB
11
)
was
focally
diminished
.
We
hypothesized
that
AAS
had
either
induced
inhibition
of
normal
ATP
8
B
1
/
ABCB
11
expression
or
triggered
initial
episodes
of
benign
recurrent
intrahepatic
cholestasis
(
BRIC
)
type
1
/
or
2
.
On
sequencing
,
ATP
8
B
1
was
normal
in
both
patients
although
the
younger
was
heterozygous
for
the
c
.
2093
G
>
A
mutation
in
ABCB
11
,
a
polymorphism
previously
encountered
in
drug-induced
liver
injury
.
AAS
marketed
as
dietary
supplements
continue
to
cause
hepatotoxicity
in
the
UK
;
underlying
mechanisms
may
include
unmasking
of
genetic
cholestatic
syndromes
.
