A person with a history of anabolic steroid abuse may experience sudden death.

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

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