The typical patient is a young adult male.
Evidence for anabolic steroid abuse:
(1) bodybuilder physique
(2) testicular atrophy
(3) abnormal testosterone to epitestosterone ratio
(4) metabolites of anabolic steroids
Cause of death:
(1) concurrent drug abuse, especially stimulants (amphetamine, cocaine, etc)
(2) cardiac disease (left ventricular hypertrophy, coronary artery disease, cardiomyopathy)
(3) cerebral hemorrhage
(4) massive pulmonary embolism
Differential diagnosis:
(1) suicide (mood disorders can be a complication of anabolic steroid use)
(2) homicide (violent behavior can be a complication of anabolic steroid use)
(3) myocarditis
The workup of a patient who abused anabolic studies and who has died suddenly should focus on:
(1) drug screen
(2) anabolic steroid testing
(3) careful examination of the heart and brain
(4) exclusion of suicide or homicide
