Penn State University Milton S. Hershey Medical Center and College of Medicine
Nabeel Akhtar, MD1, David Locke, BA2, Jonathan Stine, MD, MSc2 1Penn State University Milton S. Hershey Medical Center, Hershey, PA; 2Penn State University Milton S. Hershey Medical Center and College of Medicine, Hershey, PA
Introduction: Selective androgenic receptor modulators (SARMs) have been developed as alternatives to androgenic anabolic steroids for competitive body-building. SARMs have been shown to be acutely hepatotoxic. Here, we present a case of delayed SARM-induced liver injury.
Case Description/Methods: A previously healthy 46 year-old male initially presented to an outside facility with a 2-month history of abdominal discomfort, jaundice, pruritus, and urinary and bowel habit changes. Labs noted AST 61unit/L, ALT 115unit/L, alkaline phosphatase 173unit/L, and total bilirubin 6.9mg/dL; coagulation studies normal. Imaging did not show any evidence of acute cholecystitis, mass, or any biliary dilation. Further workup was negative for infectious, autoimmune, or infiltrative disease. Review of social history revealed insignificant alcohol or acetaminophen use but a six-month history of SARM use for body building: RAD 140, ligandrol, ostarine. He was thought to have drug-induced liver injury and was advised to discontinue the medications. He did not display any stigmata of portal hypertension, and he was discharged on an anti-histamine with follow-up. Patient was then admitted to our hospital 2 weeks later when outpatient labs noted worsening hyperbilirubinemia 22mg/dL with ALT 46unit/L, AST 44unit/L, alkaline phosphatase 434unit/L, and INR 0.8. He did not show any complications of liver disease and was discharged with Ursodiol. Then, he was readmitted a month later with a 1-week history of right-upper quadrant pain. Physical examination demonstrated hepatomegaly and jaundice. Labs continued to worsen with total bilirubin 34mg/dL. Repeat imaging studies did not show any changes. Repeat hepatitis workup was unremarkable. Patient admitted to refraining from any hepatotoxic drugs. He was discharged and evaluated for a liver transplantation 4 weeks later in clinic. He was not considered to be a candidate as his hyperbilirubinemia improved to 18mg/dL while not showing any signs or symptoms of acute liver failure.
Discussion: SARMs are currently not approved by the Food and Drug Administration because of its side effect profile that includes hepatotoxicity due to cholestatic and mild hepatocellular injuries without significant fibrosis. SARMs have been shown to cause drug-induced acute liver injury. We presented a case of chronic SARM use and delayed onset of hepatotoxicity in a patient requiring liver transplantation evaluation. Providers should complete a thorough medication reconciliation in amateur body-builders.
Disclosures: Nabeel Akhtar indicated no relevant financial relationships. David Locke indicated no relevant financial relationships. Jonathan Stine indicated no relevant financial relationships.
Nabeel Akhtar, MD1, David Locke, BA2, Jonathan Stine, MD, MSc2. P2908 - Harm by SARM: A Case of Drug-Induced Liver Injury in an Amateur Bodybuilder, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
