The Endocrine

System

andSteroids.-

Richard M s , MD. Michael Nomn, DG 0 Sophia Winward, 6s.ACE

The casual use of anabolic steroids is becoming more wide- spread in a 20hcentury cuiture that focuses on fitness and youth. Not only have professional athletes used steroids, but college students, high school students and even some middle school students have used steroids as performance-enhanc- ing aids. But the appeal of steroids is shadowed by possible negative side effects often dismissed by the general popula- tion. Essentially, the most abused steroids are manufactured com- pounds chemically related to the male sex hormone testos- terone. This hormone generates two side effects-secondary male sexual characteristics, such as a deepening voice and increased body hair, and secondly. accelerated muscle growth.

ln order to understand the threat of steroid misuse, this article will present a detailed discussion of the endocrine sys- tem and selected hormones as a preface to the use and misuse of steroids.

The functions of the human body are regulated by two meth-

ods: nerve impulses and information transmitted by the spinal

cord and brain (Figure 1) as well as the endocrine sysrem, a

network of nine glands that secrete chemicals called hor-

mones. (Figure 2) These hormones are responsible for various

functions, including resistance to stress, use of food for energy,

and reproduction. Simply, these chemical secretions, or hor-

mones, modify activity within cells, and this modification

causes a

The ductless endocrine glands convey their secretions to

specific sites via the capillaries. Hormones are circulated in

the blood throughout the body but affect only specific organs

or tissues, often termed target organs or target tissues." Hormones, such as insulin, may have multiple c a r p sites,

whereas other hormones, such as aldosterone, focus on a sin-

gle target organ, the kidneysi4 (Table 1)

There are three classiticacions of hormones: amines, pro-

teins and sreroids." Amines are simple hormones and

include thyroxine produced by the thyroid gland, and epi-

nephrine and norepinephrine, generated by the adrenal

medulla gland." Proteins are also hormones. They exist as

chains of amino acids and include insulin produced by the

pancreas. Steroid hormones represent the third group and

include cortisol and aldosterone generated by the adrenal

cortex, estrogen and progesterone from the ovaries, and

testosterone from the testes. Figure 3 illustrates many of the

glands and associated hormones in the human endocrine system.""'

HOW HORMONES FUNCTION

Initially, the body signals a need for action on a specific target

organ. A particular endocrine gland is alerted to increase hor-

- -

- - - -

- -- - - ----

TABLE 1. THE MAJOR ENDOCRINE GIANDS AND THEIR RESPECTIVE HORMONES

GLAND HORMONE TARGET TISSUE OUTCOME

Adrenal Cortex Mineralcortoids (aldosterone) Kidney Increases the rate of sodium absorption !ncreases retention of water

Glticocort~coids (cortisol) Most tissues 1nc:eases levels o i bi00d glucose. Inhibits inflammation/immune response

Androgens and estrogens Most tissues Only small quantltles secreted Majority produced by testes and ovaries.

Adrenal Medulla - ' ~ ~ i n e ~ h r i n e ,norepinephrine Heart, liver, Assists with stress. Increases heart rate blood vessels and blood pressure, increases blood

to skeletal tissue and level of glucose in blood. -.

Hypothalamus Reieasintand inhibitmg Anterior lobe of Signals production or reduction of specif~c hormones. pituitary

Ovaries Estrogens Widespread Maintains female reproduction organs and menstrual cycle. Generates secondary sexual traits

Progesterone Uterus, breast Readies uterus for pregnancy. Promotes development of mammary gland. Promotes menstrual cycle.

Pancreas Glucagon Liver Increases glycogen breakdown and causes increase in glucose level in blood.

Insulin Widespread, i3educes level of glucose in blood, stimulates glucose liver, skeletal storage as glycogec, and produces adloose. muscle, adipose

. -

Parathyroid Parathyroid (PTH) Bone, kidney. Promotes blood calcrum, increases absorption of I digestive tissue

-calcium and reduces calcium lost in urine

! Pineal Melatonin Hypothalamus Inhibits gonadotrop~n-releasing hormoce I I Regulates sleep functions i -

Pituitary Growth (GH) Widespread Promotes synthesis of protem (anterior lobe)

Thyroid-stimulating Thyroid gland Increases thyroid hormone secretion; increases size of thyroid gland.

Adrenocorticotropic (ACTH) Adrenal cortex Increases secretion of adrenocortical hormones, e.g. cortisol.

Follicle-stimulating (FSH) Ovarian follicles. Promotes follicle maturation and estrogen secretion (F); tubules of testis promotes spermatogenesis (MI.

Luteinizing(LH) Ovary Ovulation. Promotes production of progesterone. I

Testis Produces testosterone.

Prolactm Mammary S~gnals milk prodtict~on - - - - - - - - - - I

Pituitary Antidiuretic (ADH) Kidney Increases reabsorpt~on of water. ,II (posterior lobe) -

Oxytocin Mammary, uterus Increases contraction of uterus. Signals ejection of milk. i

I - - - - - - - -

i ~estes' - Testosterone Widespread Maintains male reproducthe-organs ar,d produces secondary male sexual traits

-

Thymus Thymosin Immune response Develops lmmune system and maintam filnctions. tissues

- - . - - - - -

Thyroid Thyroxine and triiodothyronme W~despread Increases rate of metabolisrr: Critical to development.

mone pralucrwn. which may directly effect the nrget organ or indirectly airnulate a

seconday endocrine gland that impacts the target o r r m Once the effeci on the

urger orcan arc rc.dwd, the stimuli in the b l a d decrc.rbr and the secretion of hor-

mone is concr~ondlnqly rduced T h ~ s negative fccdbsck is repeated in glandr again

and again all over the body.

Associative fibers from cortex \

FIGURE 1 S v m p ~ t h e t 1 cmii pan.*ympathctrc ncrvc pachwap to the various o w of the human body

For example, when an indwidual exercises and hcgim to sweat profusely, the

body's wamr content a reduced. and fluids become more salty. This saltiness signals

thc rcccptors In tiic hvpothnlamus to produce the ; ~ n r ~ r i ~ ~ r e r i c hormone (ADH). In

turn, mess.lges tc, the poxtcrior pirultary gland, which stores the hormone, signal the

nerd ro release more .SOH. More ADH increzfies the rcabmrption of water by kid-

~

of urine produced. Ultimately, the. body's water is being conserved.' '

Many bodily functions are regulated by the pituitary gland, which is located on

a ponion of rhe sphenoid bone and is

approximately I cm in size. ( F i g ~ r e . 4 ) ~ . Its two major components are the pos- .%

terior pituitary gland and the anterior

pituitary gland. (Figure 5) Besides

secreting che hormone ADH, the pas--" . ' *'

terior pituitary gland also stores the . hormone oxytocin, which stimulate8 .

the contraction of the uterus a t the -end of pregnancy and stimulates the

release of milk from the mammary , ,

glands.15

However, the anterior pituitary gland and its hormones are the focus of

the remainder of this article. Six hor-

mones are produced by the anterior

pituitary gland: growth hormonc (GH), thyroid-stinrl~liirin~hormc~nc(TSH), adrenocorticotropic hormone (ACTH),

prolactin, foll~clc-stimtilatino, hormonc

(FSH), and 1utclni:ing hormone (LH-female, ICSH-male). (Figure 3 ) Resptctively, their targets arc hones

and organs, thyroid, adrenal cortex,

breasts, testes and ovaries." Some of

their functions encompass growth, milk

production, ovulation, and sperm pro-

duction. (Table 1)

These six hormones are regulated by releasing hormones secreted in the

hypothalamus. From the hypothalamus,

the releasing hormones travel through

the hypophyseal portal veins to another

capillary nctwork in the anterior pitu-

itary gland whcre they are absorbed and

stir~lulatc secretion of these anterlor

pituitary hormones.". '5

One of the imporrant targets of the the release of stored fuels, w h h aldosterone acts on the kidneys and influencu

pituitary gland-rhc adrenal glands and um and potassium habncc. In the hoJy Cmtral of the allrenal cortex is affected b\

related hormones--regulate metabolic the adrenocorticotropic hormonc (ACTH) thar is produced by the anterior pituitz

processes (salt metabolism), production gland. (Figure 7) of ses hormones and production of

fibrous tissue throughout the b ~ d ~ . . ~ . ' ~

THE ADRENAL GLIIYDS

The adrenal gland is superior to each

kldney and composed of two parts: an

outer layer, the adrenal cortex, and an inner layer, the adrenal mecfulla.

(F~gure6 ) Each secretes very differ-

ent hormones that perform different

functions. The adrenal cortex is criti-

cal to life, hut the adrenal medulla

may be removed wlthouc conse-

quence."

In stress situations, such ds tn aero-

bic exercise or athletic competition,

thc hvpothalam~ls sends impulses to

the adrenal medulla to secrete two

hormones: eplncphrlne and norepl-

nephrine. Primarilv, they prepare the

bod\ for "flight or heht" and charge

rhc body for phvs~cal x t ion . Secreted

In small amount\, noreptncphrlne

causes vasocon~trlccion In the sktn,

vlsccra and skeletal muscles, and raises

blood pressure. Stored in larger

amounts, the hormone epinephrine

acts on the cardiovascular and pul-

monary systems, as well as a variety of

mctabol~c processes. It increases heart

rate and force of contraction, dilates

bronchioles, decreases peristalsis, Testes

increases conversion of glycogen to

glucose in the ltver, and speeds up FIGURE 2-Xl;~jor glands tn the ctrdocrtnc. sysrcm.

both the use of fat for energy and the

ratc of cellular respiration.'' Adrenocorticotropic secretion is regulated by another hormone, corricotrophir

The adrenal cortcs, the outer layer releasing hormone (CRH), which is produced by thc hypothalamus and transmitt

of the gland, produces steroid hor- to the anterior pituitar). by the portal vehsels. ACTH affects the adrenal cortex ir.

mones, primarily cortlsol and aldos- two ways. First, it stimulatcs mctabolisin and, second, it controls all adriznocorticz

terone. Cortisol affects metabolism and especially cortisol secretion."

ANATOMY OF THE ADRENAL CORTEX

The nJrena1 cartcs is divided into three zoncs, and w c h mantrfacrures a different

c1;l.i~ot steroid hmnonc. The ourcr layer, the 20113. Giomerulosa, PrC)JI~ces aidos-tcranc, also known as a minrralocorricoid; the inner laycr, Zona Fasciculata, pro-

duces cortisol, also cdlcd gluctxxrricoid; and the innermost area, Zona Reticularis,

procluccs androgens. (Fikwre 6 )

PRIMARY HORMONES OF THE ADRENAL CORI'EX

Aldosteronos are hormoncs that incrcase thc~ blood sodium and dccroasa blood

potxsit~in during periods of physical exertion. While swe:lting, the human h d y loses

f;tlt and hlood pressure drops. Low blood pressure in the nephron of thc kidney caus-

cs the kiclncy to relcax rcnin. Thc renin sign;ds the production of a vasoconstrictor,

angiotcnsinogen, and blood pressure sulscqucntly rises. Tho angiotensinogcn pro-

motes aldostcrone secretion which con-

s c n u sodium m d water. This indirect

cffcct of a lc i~~~tcronemeans that normal

b l ~ m ~ !vcAnne and blood pressure

remain relatively constant. Essentially,

aldosterone maintains normal blood

levels of wdwm and potassium and

contributes to the maintenance of nor-

mal blood pH, blood volume and blood

pressure.". " Gxtisol is secreted in any type of

physiological stress situation, including

discase, physical injury, hemorrhage,

anger, exercise and hunger. Cortisol has an anti-inflammatory effect. When

inflammation occurs,damaged tissue

within the body releases histamine that

makes capillaries more permeable.

Although more cnqmes break down

damaged tissue, they may also cause

destruction of hralrhy tissue."

Cortisol blocks the effects of hista-

mine and srabili:es lysosomal mem-

branes, preventing excessive t i sue

destructmn. Under normal secretion,

corriwl hcefila ro limit thc ~n t l anma-

tion process to what is uscft~l for tissue

rrptir and prcvcnr cxcesslve tlssuc

destructlcm. Abnormal secretion or

csccss cortisol 'iecreascs the immune

response, making the body susceptible

to infection and decreases the healing

of damaged tlsbue. Cortisol secretion is

conm)lIed by the hormone .4CTH from the antertor p~tuicary gland. In

turn, thc gland is sclmulated by corti-

cotropin relcasm~ hormone (CRH) from the hypothalamus.

The inncrrnost layer of the adrenal

cortex secretes small amounts of andro-

gens, the male sex hormone, that exert

masculln~xng eff&r>, or estrogen, the

female sex hormone. T h e adrenal gland

also sccrutus two other hormones, dehy-

dchydrorpiandrosterontl (DHEA) and

testosterone. which is prim;lrily pro.

ih~ccdby the testes. In female adrenal

glitnd~, androgens may contribute to

the sex drive and other sexual hhavior.

Fcm;lle androgens may also be conven-

cd into the hormone estrogen by other

body tissues. This transformation is sig-

nificant when ovarian estrogen dimin-

ishes during menopause. Adrenal

androgens also contribute to growth

spurts occurring during pub;rty.M.?'

ANABOLIC STEROIDS

As we have seen, naturally occurring

hormoncs or steroids in the M y can

genecm very positive side effects

dcr~landed in specific situations, includ-

ing balance of blcwd volume, increasing

heart mte, conservation of fluids, to

name just a fcw. However, when the

side effects heconlc rhc goal, and artifi-

cial means, such as anaholic steroids,

x e used to entx~ncc thew objectives of

physical performmcc, negative eifects

may occur.'"

Muscle-growing or "anaholic"

steroids, also produce male sexual char-

acteristics (:inJrogrns) to some degree.

The difference bctwecn the man): ana-

bolic cornpounds is based upon the

ratio of androgenic to anabolic CUsu~rs . i 123.27

In 19 39, steroids were believed to

improve physic:d performancc,33 and

bcfort. WWII. they were administered

to furrher healing and hasten recovery.

Okwrvcrs noticcd that the moods of

steroid users varied quickly. During the

war, rumors circul:lted widely of

C'lornlan tioldiers consuming steroids to

hnosr their .srrength i d Ilostility. In

the 196& steroids wcrc medically prr-

scribcd to incrcasc strength, vigor,

appcrtte, and weight. Adult women, vounq women, children and preschoolers were

observed for any evidrncc of h~rsur~sm,x n c or voicc chmge." (Table 2) %day, athletes use sterods to enhnncc their lean body m;iss, increase strength,

hc1ghtr.n aggressiveness and reduce recovcq trme berwccn workouts. Lim~ted evi-

dence 1s avallablc to Support these practices, but med~csl ethics has prohibited

exhaustive testrng of sterotcfs In controlled studtes, because the dosages involved are

consderrd dangerous.

Sella turcica of iphenoid bone'

i I

FIGURE 8-Antertar nrd p t c r t o r ptuitnry Slanils Itc on n prrton of the sphenoid hone.

Three distinct types of steroid usc are practiced: stacking, cycling and Stacking involvcs the sirnultancous use of scvcral different steroids to

optlmlze the muscle growth effects and reduce the scconcian; sexual characterisrics.

Cycling describes n repcrlrlvc xqtlence of drugs alternarclg takcn over a per id of six

to 12 weeks. Theoret~cally, cycl~ng prcvcncs the user from developing a tolerance to

steroids. Pyramiding involves c;lk~ng law doses of the drugs and increasing the

amounts for several weeks, then decreasing the dosage to zero before competition.

Often, steroid abusers combine all three approaches.

Multiplc surveys indicate approximately i percent of high schooi males and 1per-

cent of high school females use steroids. When the National Collegiate Athletic

Association announced a drug testing program, steroids were detected in only about

1 percent of the athletes. However, when the International Olympic Committee

,. . . * 4.". <,? .*. Hypothalamus

, , . ., * w s '<

lafundibulum

Pan intermedia

Pars newosa

RGURE StAncer~orand pxrerior prtuitary glands.

administered a surprisc test for steroids, the results showed that 50percent of the

athletes tested positive for steroids.".""'

How rterpidr are metabolized

Approsimately 5 perccnt of testosterone originates in the adrenal glands and the

remainder is synthesized in the testes. Acetate stored in the testes produces choles-

i

--L I ,

.--

terol. In turn, this cholesterol synthe-

sizes testosterone. In the mitochondria,

the cholesterol changes into preg-

nenolone, and it moves to the end? .

plasmic rec~culum where a three-step

process results in tes~osterone.~Once testosterone is produced, it immediately

*. . . circulates in the bloodstream. ' *. + .

*f .., : Approximately half anaches to aglyco-- :

protein, produced in the liver, the sex-

hormone-b~nding globulin (SHBG), ' and thc remainder loosely binds to -. % L."w.T.y..,

albumin." -_ i-A "

When administered orally, nearly half of the testosterone will be m e t a b -

'

lized by the liver on the first pass." Consequently, very large doses are ,

required to generate any therapeutic

effect. Approximately 90 percent of a

dose of testosterone will be excreted in

the urine as the glucuronic or sulfuric

acid conjugates."

Legitimate considerations for andro-

gens involve testicular faihre and

metastic brellst cancer with bone

tnvolvernmt. Anabolic steroids, such as

Winstrol". are prescribed only for

hereditary angioedema.'.'.4 Substances

that demonstrate both androgenic and

anabolic results are also indicated for

treatment of deficient red cell produc-

tion, such as aplastic anemia and

myel~fibrosis.~'

S a n d Stsroid~

In 1990, the Anabolic Steroids Control

Act regulating the control of anabolic

steroids was passed and created an

increase in the importation of illegal

substances. Thc depressant, pmma

hydroxyhutyric aciJ (GHB), bccamc

popular in the early 1990s when body-

builders h l~eved that it would promote

the release of growth hormone. While

the average dose is only a few grams,large quantities can

cause nausea, vertigo, seizures and respiratory depression."

Steroids can be taken both orally and by injection, and

serious athletes favor injection. However, while they demon-

strate the most dramatic effects, they also are responsible for

the most severe side effects, such as liver cancer (hepatic tumors and jaundice), cardiovascular disease (hypercholes-

terolemia, arrhythmias, stroke and cardiomyopathy), psycho-

logical (depression) and sex roids,

TABU 2 SYMPTOMS OF STEROID ABUSE . Muscular hypertrophy

Decreased pituitary and adrenal function

Increased susceptibility to infection

Peptic ulcer disease

Psychological disturbances including suicidal tendencies

Osteoporosis

Pre-pubertal penile enlargement

Post-pubertal testicular atrophy

Oligospermia

Impotence

Gynocomastia

Deepening of the voice in women

Hirsutism and male pattern baldness in women

Acne

Premature closure of epiphyseal plates

Sodium and potassium imbalances

Decrease in glucose tolerance

Increase in LDL and decrease in HDL

including prednisone and dexamethasone are available in oral

forms and as topic creams and lotions for psarasis, allergic reactions and skin disease. The most popular drugs are testos-

terone (not a steroid) and human growth h ~ r m o n e . ' ~ ~ ~ ~ "

(Table 3 )

PhpicaI Hlscts

Steroid abuse generates several negative side effects, including

liver disease, cardiovascular disease, neurological problems

and musculoskeletal disease." In 1952, a direct link &tween peliosis and anabolic steroid use was made. Small, scattered, cystic blood pools present throughout the liver, and possibly

the spleen, lymph nodes and bone marrow are also involved.

Although the cause of peliosis is still under investigation, one recent autopsy indicated that one third of die patients who

used steroids had peliosis. Seventeen alkylated a&drogens have been involved in all of the studies of peliosis and steroid cases.33

TABLE 3 COMMERCIAL STEROIDSn

Steroids administered by injection:

Deca-Durbolin (Nandrolone decanoate)

Depo-Testosterone (Testosterone cypionate)

Delatestvl (Testosterone enanthatel

Durabolin (Nandrolone phenpropionate)

Oreton (Testosterone propionate)

Primobol (Methenolone enanthate)

Oral agents:

Anadrol-50 (Oxymetholone)

Anavar (Oxandrolone)

Dianabol (Methandrostenolone)

Halotestin (Fluoxymesterone)

Maxibolin (Ethylestrenol)

Metandren (Methyltestosterone)

Nibal (Methenolone acetate)

Nilevar (Norethandrolone)

Winstrol (Stanozolol)

Cholestatic jaundice is also attributed to these same 17 steroids. I t is characterized by the accumulation of bile in the

canaliculi without showing necrosis or inflammation.

Estimates of frequency range from 1 percent to 17 percent.

While the evidence of a direct relationship appears firm, the

spec~fic proof of causality has not been found."

The occurrence of hepatic tumors ahd the use of alkylated

androgens also demonstrates a relationship. Hepatocellular

adenomas appear like normal hepatocytes but androgen-

-. related adenomas arc: usually larger and can range in size from a few millimeten to sis are produced in other animal studies several centimeters in ~ i i a m r t r r . ~ ~ I These adenomas may show irregular nuclei and and, again, present strong possibilities actnt format~on but are usually bentgn and regress when androgen use is discontin- for arrhythmic death."3"*.41 wd. However, the posslhtl~ty of adenoma changing to carctnoma remains a possi- Studies have found instances of b i l q 's." infarction when a weightlifter con-

sumed both aspirin and testosterone

simultane~usly.~.Anocher weightlifter INFERIOR VENA CAVA

I who used steroids showed arterial I >* ,,5:,

ADRENAL GLAND thrombosis." - %-,-.-42

KIDNEY If steroid abwers are more suscepti-5 I I I ble to thrombosis and infarction, one

possible cause may be a 50 percent -. -. w

decrease in their high-density lipopro-

tein levels and a corresponding increase

in their low-density lipoprotein levels:? L .

This change produces an increase in .

cholesterol (hypercholesterolemia),

which can lead to hyperinsulinemia (associated with athc:rogenesis)."~ *."

Cardiomyopathy presents another AORTA possibility as a cause for sudden death

in athletes. Animals in exprimental

research studies that were given

methandrostenolone showed myocyte

necrosis, cellular edema and mitochon- drial ~ w e l l i n ~ . ~ " . ' ~ Whether anabolic

steroids negate cardiac improvement

from endurance training is still being

debated. However, research has'proven

that animals' hearts experience mor-

URETER URETER phologic change after the administra- "\v tion of steroids. These changes, such as

modulation of increased collagen pro-

duction, mitochondria\ disruption and a

URnHRA reduction in myocyte capillary supply,

are specific to steroid use and vary from FIGURE &Adrenal gland relat~vcro the ktdncv. the physiologic changes produced by

exercise."

If similar changes occur in human

Young steroid users have also experienced myocardial infarction, arrhythmic hearts, then some deaths attributed to death and stroke. Reports have described the hearts of athletes as anatomically dif- cardiac arrest could be explained. In ferent, and anabolic androgens directly impact cardlac growth, myocyte metabolism one case report, a 21-year old and platelet function. Animal stud~es indicatc that testosterone increases the pres- weightlifter who had a history of ~ ence of thrornboxane. In cum, clots could result. Myocardtal hy~ertrophy and fibre- steroid abuse (nandrolone and testos-

terone) d ~ e d uncspectcdly. Results showed renal hypertro-

phy and hcp~tosplenomeplly and biventricular hypertro-

phy with chamber dilation. The heart weighed 530 grams

but the valves and coronary arteries were within normal

ranges. Extensive fibrosis was evident in the subendocardl-

um and the central parts of the left ventricle and intraven-

tricular septum. A particular area of fibrosis exceeded more

than 8 ~ m . ~ , ~ '

Such physical conditions may be caused by muscle fiber

hypertrophy that is not accompanied by the necessary increas-

es in the blood supply. Ultimately, small infarctions may

result. Fibrosis occurs when these infarctions heal. Other

physiologic causes may be identified eventually. However,

FIGURE 7-Pnth~ny of .~d:cn*xorr~cotroptchormone (ACTH)

fibrotic material has conduction properties unlike normal

muscle and fibrotic tissue may be a strategic factor involved in

cardiac arrhythmias."

Steroid-caused psychiatric disorders are frequently observed

and have h e n used as a defense in murder trials. In one study

of 41 steroid abusers, 22 percent showed affective disorders

(aggressive behavior and depression) and 12 percent cxperi-

enced psychosis. In other instances, men caking steroids com-

mitted violent crimes, including murder, and returned to their

normal personalities aftcr cessation. Lhmestic abuse has also

been attributed to the use of steroidb."

Controlled btud~cs have proven a direct correlation

between mood disorders and steroid use. In one research

study, two group took high and low doses of methyltestos- 11teronc. Pxtic ,pants involved in the high dosage study

demonstrated mod chmges including euphoria, irritability,

mood swings dnd confusion. In another rexarch study,

steroid-abusing arhletes and non-steroid using participants

were compared for physical and psychiatric data. The steroid-

abusing athletes showed more freyuent gynecomastia,

decreased mean testicular strength, and higher cholesterol. In

addition, a high percentage of the steroid users d e m o n k t e d ,

evidence of mood disorders, including mania, hypomania or major depression."

There is little evidence beyond animal studies to relate

steroid abuse to musculoskeletal disease. Animals konditioned '

Zona Glomerulosa "

FIGURE 8-AJrcnal corres: thc rhrw :onus.

to exercise that have been administered anabolic steroids

have a reduced number of capillaries per muscle fiber while the amount of fatty and connective tissue in their muscles has

increased." The hypertrophied muscles will not have an effi-cient exchange of respiratory gases and eventually patchy fiber

necrosis could result.4!

CONCLUSION

Body builders and athletes who use high doses of steroids

axpcriance difficulty wlth any type of surgical repair for

injuries. Surgcq [nay nccJ to bc delayed as much as six to

seven weeks to allow the patient to metaboli:e the synthetic

steroids and allow a return of the body's natural production of

I

steroid hormones. Otherwise, a fatal risk of adrenal supprcs-

sion during surfer), is a possible risk.

I t is vital to educate all levels of the population regarding

rhc harmful conscquenccs of steroid abuse. Additional

rcscarch stud~es need to be initiated, and standardized testing

f o r the prescnce of stcroiJs must he crcated. A discussion

regarding the priorities of health versus physical prowess and

personal attributes would be beneficial, especially to children

3rd young adu1ts.A

ABOUT THE AUTHORS '

Kichard Wills, MD,MBA. ACSM, is a professor of sports medi-

cine at Utah Career College, adjunct professor of health and

nutrition at Utah Valley State College, owner of

intermountain MeJical Research and Development and is a

fellow with the American College of Sports Medicine. Wills has also been a professional body builder for 35 years.

Michael Norton, m, is a chiropractic physician in private

practice and owner of Science Instruction Srviccs.

D Sophia Winward, BS,ACE, is program director and chair

at Utah Career College Sports Medicine and Fitness

Technologies Departmcnt. She serves as functional fitness

associate and exercise rchabilitatwn consultant.

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