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1 9 - 0 1 - 2 0 0 5 Medico-legal aspects of doping
B. Madea, W. Grellner, E Musshoff, R. Dettmeyer
Abstract Abuse of anabolic steroids is an increasing problem not only among athletes but also body-builders and teenagers. A fast-developing black market has been established since the opening of the borders to eastern Europe. Medico-legal aspects of doping are addressed with particular reference to toxicology and pathology. Constituents of anabolic steroids bought on the black market were identified using gas chromatography/mass spectrometry; the products did not contain the expected ingredients in 35% of cases. Long-term effects and fatalities because of anabolic steroid abuse are reported here based on our own case material and a literature review. In our own cases, severe cardiovascular side-effects developed after long-term abuse of Dianabol (methandrostenolone) and Oral-Turinabol (chlordehydromethyltestosterone), i.e. myocardial infarction, stroke, organomegaly and/or severe atherosclerosis. The pathogenesis of cardiovascular complications (cardiotoxic effect, risk of atherosclerosis, thrombogenic risk) is discussed based on the available literature reports following fatal outcome after the abuse of anabolic steroids.
Case 1 A 41-year-old male, professional body-builder had used 'cycles' of two oral anabolic steroids before competitions for 8 years. Following a 4-week lasting cycle in 1993, he suffered a brainstem infarction with intermittent hemiparesis. Persistent dizziness and dysarthria subsequently developed. Posterolateral myocardial infarction was diagnosed with the differential diagnosis of toxic cardiomyopathy. The neurological diagnosis comprised multiple cerebellar and brainstem infarctions. The man lost his job as a trainer in a sport centre due to his physical condition. On the day of his death, he was found unconscious in a sport centre and taken to hospital. He discharged himself against the advice of the doctors. That evening, he was found dead at home by his wife, with a pistol beside him.
Autopsy findings Autopsy showed an athletic constitution with a body weight of 89.9 kg and a height of 177 cm (body-mass index: 28.7 kg/m 2, normal: 20-25 kg/m2). Old myocardial infarction of the anterior and posterior wall of the left chamber of the heart with aneurysm formation of the posterior wall was present. Fresh myocardial necrotic areas were present at the margin of the scar of the anterior wall.
Apart from the infarction scars, disseminated myocardial fibrosis was found. The heart was hypertrophied (heart weight: 470 g [normal: 0.4% of body weight = 360 g]; ventricular wall: left 18mm [normal: ll-14mm], right 7mm [normal: 3 mm]).
Case 2 For 13 years, a 28-year-old male had undertaken extensive body-building with simultaneous abuse of anabolic-androgenic steroids (Dianabol, Oral-Turinabol). Documented pre-existing disease due to the adverse effects of his substance use included arterial hypertension (210/120 mm Hg), mood disorders with depression, bone fractures, rupture of the pectoralis major muscle, rupture of the quadriceps femoris muscle and secondary hypogonadism. Severe disturbances of lipid metabolism (decreased HDL-cholesterol and markedly raised LDL-cholesterol) were repeatedly diagnosed during sport medical examinations.
In 1992, 2 years prior to death, the following diagnoses were made: marked obesity, arterial hypertension, damage of the liver parenchyma, hypertrophy of the left ventricular wall, disorder of the lipid metabolism. After a medical examination in 1992, the man had been warned of the dangers of anabolic steroid abuse and the risk factors to his health.
Autopsy findings
Autopsy demonstrated a heavily muscled 28-year-old male with signs of marked obesity, a body weight of 136 kg and a body height of 178 cm. The body-mass index was 42.9 kg/m2 [normal: 20-25 kg/m2].
Numerous striae of the chest and upper extremities were present resulting from obesity. Toxicologic analysis revealed
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