[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance." (Wilmore and Costill)

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A case of cutis verticis gyrata, induced by misuse of anabolic substances?

A. Sommer, T. Gambichler, P. Altmeyer and A. Kreuter
Clinical and Experimental Dermatology, 31, 129–156

Cutis verticis gyrata (CVG) is a descriptive term used for a rare condition of the scalp manifesting as convoluted folds and furrows in a cerebriform pattern, which are caused by thickening of the skin.

Cutis verticis gyrata may be categorized as primary essential, primary nonessential, and secondary. The aetiology of primary essential cutis verticis gyratais still unknown, although genetic and endocrinological factors are suspected to be of pathogenetic relevance.

Primary nonessential cutis verticis gyrata is strongly associated with psychiatric or neurological disorders such as schizophrenia, epilepsy and mental retardation. Additionally, ophthalmological symptoms including cataract and blindness may be observed.

In secondary cutis verticis gyrata, systemic diseases, inflammatory dermatoses, naevoid abnormalities, and trauma are considered to be underlying conditions.

A case of cutis verticis gyrata, induced by misuse of anabolic substances?
We describe the case of a 26-year-old male bodybuilder of Mediterranean descent, who developed cutis verticis gyrata after extensive misuse of anabolic substances. He presented with a 6-month history of slowly progressing vertical linear folding and deep furrows in the occipital and parietal area of his scalp.

The patient had gained 55 kg during the 2 years prior to presentation, increasing his bodyweight from 60 to 115 kg (body mass index increasing from 19.2 to 36.7).

A case of cutis verticis gyrata, induced by misuse of anabolic substances?
Clinical examination was otherwise unremarkable. A skin biopsy specimen of the scalp showed acanthosis of the epidermis, dermal thickening of collagen bundles, and a lymphohistiocytic perivascular infiltrate in the upper corial plexus. He was otherwise well.

Laboratory investigations showed elevated liver enzymes (alanine amino transferase 58 U / L, aspartate amino transferase 81 U / L, and gamma glutamyl transferase 56 U / L).

Sex hormone profile was unremarkable. Acromegaly and pachydermoperiostosis could be excluded by laboratory (growth hormone level <0.5 ng / mL) and radiological examination.

The patient denied any intake of medication, but admitted to have taken several different anabolic steroids, obtained on the black market, to gain muscle mass. The intake ceased 3 months prior to his first presentation in our clinic.

Based on the clinical features, absence of further relevant symptoms (such as neurological and ophthalmological disorders), no signs of underlying diseases in histopathology, and concomitant occurrence of the scalp condition and hormone intake, we diagnosed cutis verticis gyrata secondary to misuse of anabolic substances.

The anabolic steroids very likely also caused the reduction of somatotropin via steroid-induced hormone suppression and the elevation of liver enzymes observed in our patient.

Association of cutis verticis gyrata with misuse of anabolics has not previously been documented in the literature. We cannot fully exclude that our patient actually suffered from primary cutis verticis gyrata (which is seen in higher prevalence in patients of Mediterranean, i.e. Italian, descent than in the general white population) that coincidentally occurred with the misuse of anabolics.

The extraordinary history of our patient suggesting interference of endocrine feedback mechanisms, particularly of the pituitary–gonadal axis, give reason for the assumption that the development of cutis verticis gyrata might have been induced by the misuse of anabolic steroids.

Our patient reported 15 different anabolics he had taken, partly in combination and partly as single medication. Some of the mentioned substances (e.g. nandrolone decanoate, nandrolone laurate, trenbolone cyclohexylmethylcarbonate) are known to strongly interfere with the endogenous hormone production and to suppress gonadotropin levels (e.g. methenolone), and may lead to atrophy of the testes (one example being Sustanon, containing a combination of testosterone propionate, testosterone phenylpropionate, testosterone isocaproate and testosterone decanoate).

In addition, the known oestrogen conversion abilities of the substances may lead to hormone-induced side-effects in male consumers (for example, those using Omnadren, containing testosterone hexanoate, testosterone propionate, testosterone phenylpropionate and testosterone isocaproate).

We conclude that the excessive consumption of anabolic steroids and the associated invasion of the endogenous hormone production might be of pathogenetic relevance in the development of cutis verticis gyrata in our patient. This observation supports the possible pathogenetic significance of endocrinological disorders in the aetiology of cutis verticis gyrata.

[PMID: 16309509]




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