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

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Medico-legal aspects of doping

B. Madea, W. Grellner, E Musshoff, R. Dettmeyer
J Clin Forensic Med. 1998 Mar;5(1):1-7.
PMID: 15335551


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]).
Only slight coronary atherosclerosis and no cerebral atherosclerosis were present. Encephalomalacia of the brainstem and cerebellum and an old infarction of the right kidney were present. The cause of death was a contact wound to the right temple with a skull-brain through and through shot.

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.

Medico-legal aspects of doping - Long-term effects and fatalities caused by anabolic steroid abuse

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.
Symptoms prior to death included dyspnoea, a feeling of a lump in the throat, inability to sleep in a horizontal position and marked peripheral oedema with an increase in body weight of 3 kg per day.

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].
Hypertrophy of nearly all inner organs except the brain was observed with the following organ weights: heart 800 g [critical heart weight = 500 g], liver 5710 g [reference: ~ 1500 g], kidney 910 g [reference: ~ 150 g].
The cardiac findings included a 'cor bovinum' with hypertrophy of the right and left ventricular wall and an additional dilatation of all chambers.
Histologically, disseminated interstitial and perivascular fibrosis and some spotty scars could be demonstrated. Signs of chronic heart insufficiency comprised chronic congestion of the liver and spleen. Oedema of the lower extremities and chronic and acute congestion of the lung with pulmonary oedema and interstitial fibrosis were present. Pulmonary siderosis was present. In addition, massive general atherosclerosis with fat pads of the aorta, coronary and pulmonary atherosclerosis were observed.

Numerous striae of the chest and upper extremities were present resulting from obesity. Toxicologic analysis revealed
Medico-legal aspects of doping - Long-term effects and fatalities caused by anabolic steroid abuse

.massive general atherosclerosis with fat pads of the aorta...

diazepam and verapamil in therapeutic ranges. Cause of death was given as heart failure due to cor bovinum after long-term abuse of anabolic steroids. Consistent with advanced atherosclerosis repeated disorders of lipid metabolism were recorded with a depression of HDL-cholesterol and elevation of LDL-cholesterol. This atherogenic lipid profile has been repeatedly reproduced as typical of anabolic steroid use both in animal and in human experiments.




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