Drug-induced Acute Pancreatitis in a Bodybuilder

A Case Report

Seyed Ali Safizadeh Shabestari; Samuel B. Ho; Priyadarshini Chaudhary; Rahul A. Nathwani

J Med Case Reports. 2022;16(114)

Abstract and Introduction

Abstract

Background: Unregulated use of a variety of drugs and supplements by bodybuilders and athletes is common and can lead to severe adverse complications. Only a small proportion of acute pancreatitis cases are drug induced, and case reports are essential for identifying potential drug-related risks for pancreatitis. Here we present the first case report published of acute pancreatitis linked to recreational use of anabolic–androgenic steroids, subcutaneous growth hormone, and clenbuterol in a previously healthy male after excluding all other causes of pancreatitis.

Case Presentation:A 31-year-old Arab male bodybuilder presented with acute abdominal pain associated with nausea and sharp pain radiating to the back. The patient was not using tobacco or alcohol but was using multiple drugs related to bodybuilding, including anabolic–androgenic steroids, subcutaneous growth hormone, clenbuterol, and multiple vitamin supplements. Laboratory studies revealed a normal white blood cell count, elevated C-reactive protein, minimally elevated aspartate aminotransferase and total bilirubin with normal remaining liver tests, and elevated amylase and lipase. The patient had no hypertriglyceridemia or hypercalcemia, and had had no recent infections, abdominal procedures, trauma, or scorpion exposure. Imaging and laboratory investigations were negative for biliary disease and IgG4 disease. Abdominal computed tomography revealed hepatomegaly and diffuse thickening and edema of the body and tail of the pancreas with peripancreatic fat stranding.

Abstract and Introduction
Case Presentation
Discussion
Conclusion
References

Table 1. Timeline table
Relevant past medical history and interventions
Past medical history insignificant for any pancreatic diseases or risk factors. He admitted to using anabolic–androgenic steroids, clenbuterol, multiple vitamin supplements, and growth hormone injection from an inexpensive supplier at double the recommended dose
Summaries from initial and follow-up visits	Diagnostic testing	Interventions
Based on clinical presentation and CT findings, the patient was diagnosed with acute pancreatitis with Bedside Index of Severity in Acute Pancreatitis (BISAP) score of 0 (< 1% risk of mortality), which is characterized by the absence of organ failure and local or systemic complications. During his hospital stay, the patient was managed with aggressive intravenous hydration and pain management, with significant improvement noticed within 3 days, after which he was discharged home	Laboratory studies: amylase, lipase	Discontinuation of offending drugs (anabolic–androgenic steroids, subcutaneous growth hormone, and clenbuterol); aggressive intravenous hydration and pain management
Patient had no further episodes of pancreatitis during 2 years of follow-up	Imaging: abdominal CT, abdominal ultrasound

Table 2. Cases of acute pancreatitis associated with drugs related to weightlifting or bodybuilding
Case	Patient	Findings	Drug(s) taken	Delay between introduction of the drug and pancreatitis	Rechallenge	Outcome
Safizadeh Shabestari et al. 2021 (our case)	31-year-old male	Elevated amylase and lipase, with CT abdomen showing pancreatitis	Fluoxymesterone, mesterolone, drostanolone propionate, stanozolol, tamoxifen, testosterone enanthate, testosterone propionate, clenbuterol, and growth hormone	1 month	Not performed	Clinical improvement with fluid hydration and pain management
Kumar et al. [16]	24-year-old male	Elevated amylase and lipase, with CT abdomen showing pancreatitis	Trenbolone acetate	Several months	Not performed	Clinical improvement with conservative treatment
Binet et al. [27]	28-year-old male	Isolated elevation of lipase, with CT abdomen showing pancreatitis	L-Arginine alpha-ketoglutarate and other vitamins and supplements	18 months	Not performed	Clinical improvement with conservative treatment
Liane et al. 2016 [5]	20-year-old male	Elevated amylase and lipase, LDH, and CK, with CT abdomen showing pancreatitis	Anabolic–androgenic steroid called "Guerilla Warfare"	1 month	Not performed	Clinical improvement with fluid hydration and pain management
Garg [17]	28-year-old male	Elevated amylase and lipase, with ultrasonography abdomen showing pancreatitis	Anabolic–androgenic steroid	Data unavailable	Not performed	Patient died
Rosenfeld et al. [28]	50-year-old male	Elevated lipase and triglycerides, with CT abdomen showing pancreatitis	Methandrostenolone	2 months	Not performed	Supportive therapy
Schäfer et al. [29]	26-year-old male	Hypercalcemia and elevated lactate dehydrogenase and pancreatic amylase, with CT abdomen showing pancreatitis	Oxymetholone, nandrolone decanoate, testosterone, epitestosterone, and erythropoietin	After second annual injection cycle	Not performed	Aggressive intravenous rehydration, transferred to intensive care unit because of anuria
Samaha et al. [2]	24-year-old male	Leukocytosis with left shift, hypercalcemia, and elevated amylase, lipase, and CPK	Testosterone	2 months	Not performed	Slow clinical improvement with fluid hydration and pain management
Rutten et al. [21]	40-year-old male	Elevated amylase and CRP with abdominal ultrasonography	Growth hormone	2 weeks	Not performed	Conservative treatment
Saka et al. [15]	16-year-old male	Elevated amylase and lipase with CT abdomen showing pancreatitis	L-Arginine and zinc	5 months	Not performed	Clinical improvement with ciprofloxacin, fluids, and bowel rest