Introduction: Common causes of acute pancreatitis (AP) in the United States are gallstone pancreatitis and alcohol use. However, about 2% of AP cases are attributed to Drug-induced pancreatitis (DIP). Though infrequent, the pathology is associated with substantial morbidity and mortality, which makes timely identification of the inflicting agent important. Supplements that enhance athletic performance and libido are commonplace in today’s community and remain largely unregulated. The lack of understanding and awareness of the detrimental adverse effects of such drugs can affect physical and mental health.
Case Description/Methods: A 51-year-old gentleman with a history of chronic kidney disease Stage II, hyperlipidemia on statin, diverticulosis, and GERD on omeprazole presented to the ER with acute abdominal pain associated with nausea and vomiting for a day. The epigastric pain was described as 10/10 in intensity, sharp with radiation to the back and associated with 3 episodes of non-projectile, bilious, non-bloody vomiting. He is a non-smoker and drinks alcohol occasionally, his last drink being a can of beer 1 week prior. He denied recent infections, abdominal procedures, or trauma. On examination, his vitals were normal, and was in minimal distress. Tenderness was elicited in the epigastric region. Initial labs showed leukocytosis with left shift, elevated AST of 225, ALT of 202, LDH of 274, and a significant increase in levels of lipase >3000. A CT scan of the abdomen showed findings consistent with acute interstitial pancreatitis. Imaging and laboratory investigations were negative for biliary disease and IgG4 disease. On asking further history, he reported taking over the counter testosterone supplements to enhance his libido for 2 weeks. A diagnosis of DIP was made and was treated appropriately with aggressive hydration and pain management.
Discussion: DIP is attributed to four classes of drugs (I to IV) and steroids like testosterone are placed under Class I. The possible mechanism for causing AP include pancreatic duct constriction, cytotoxic and metabolic effects, accumulation of a toxic metabolite or intermediary, and hypersensitivity reactions. Prevalent use of testosterone in the male community for bodybuilding and increasing libido warrant the need to create awareness. Additionally, these drugs are difficult to study due to the varied consumption patterns, unknown origin and ingestion of high doses.
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