Steroid Abuse and Hepatitis

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Last Updated on March 27, 2021 by Atif

In the world of sports, anabolic steroids and other performance-enhancing drugs are becoming increasingly popular. Their use has become so widespread that some athletes will feel that if they don’t use them, they won’t be successful.

Steroid use, on the other hand, carries significant health hazards, including the possibility of developing a chronic and possibly fatal case of hepatitis. Steroid use can cause liver disorders and tumours, according to the Mayo Clinic. How Do Steroid Users Get Hepatitis?

What Is Hepatitis and How Does It Affect You?

Hepatitis is a condition in which the liver swells and becomes inflamed. It can be caused by a virus or it can be the result of liver damage caused by other factors including chronic alcoholism. Hepatitis incidence is determined by a variety of factors. Hepatitis A is the least serious type of hepatitis; it is normally short-lived, and patients typically recover without medical intervention. Hepatitis B is a more severe infection that causes liver inflammation as the body’s immune system tries to combat the infection. If the body is able to effectively combat the infection, the symptoms should go away after a few weeks or months. Hepatitis C, also known as HCV, is the most severe type of the virus and is linked to steroid abuse. People who have hepatitis C often have no symptoms at first, so they may be entirely unaware that they have the disease. Jaundice (a yellowing of the skin) may occur in some people at first, but it usually goes away after a few days. Otherwise, the individual can appear to be perfectly normal before advanced liver damage symptoms appear.

The virus may have already caused severe scarring of the liver, known as cirrhosis, by the time it is detected. Hepatitis C can also lead to cancer of the liver. Hepatitis C is normally chronic, and treatment involves eliminating the virus from the bloodstream while reducing liver harm. A liver transplant may be required in some cases to save the patient’s life; however, most liver transplants result in hepatitis re-emerging in the new liver.

How Do Steroid Users Get Hepatitis?

Steroids have the ability to harm the liver and induce hepatitis. Many athletes abuse steroid dosages that are much too high, increasing the risk of liver damage. The consequences of taking such heavy doses of steroids are unknown.

Clinical studies containing exorbitantly large levels of steroids would put the research subjects at risk of severe health issues, so they haven’t been performed. The majority of evidence for the effects of high doses of steroids comes from studies of individuals who took the medications on their own. Even at therapeutic doses used for medical purposes, steroids can cause liver harm, so it’s safe to believe that higher doses will increase the risk.

Indirectly, steroid use can induce hepatitis if a tainted needle is used during intravenous injection.

It is very normal to contract hepatitis by coming into contact with the blood of someone who has been infected with the virus. Hepatitis is a possibility for anyone who injects drugs of any kind, and steroids are no exception.

Corticosteroids significantly impact the liver, Especially when used over a prolonged period of time and at doses higher than physiologic. Glucocorticoid use can cause hepatic enlargement, steatosis, and glycogenosis. Corticosteroids may cause or aggravate nonalcoholic steatohepatitis. Chronic viral hepatitis can be exacerbated by long-term use. Importantly, Hepatitis B reactivation, as well as worsening or de novo induction of autoimmune hepatitis, can all be fatal if corticosteroid medication is combined with withdrawal or pulse therapy. Finally, high doses of intravenous corticosteroids, particularly methylprednisolone, have been linked to acute liver injury, which can lead to acute liver failure and death. As a consequence, corticosteroid-related hepatic complications are normally the result of the worsening or activation of underlying liver disease, rather than drug hepatotoxicity.

Hepatic steatosis and enlargement may be caused by corticosteroid treatment, but this is often not clinically evident, particularly in adults. This effect will happen quickly and is quickly reversed when the effect is stopped. Nonalcoholic steatohepatitis has been linked to high doses and long-term use, with steatosis, chronic inflammation, and centrilobular ballooning degeneration, and liver histology similar to alcoholic hepatitis, including steatosis, chronic inflammation, and centrolobular ballooning degeneration, and Mallory bodies (Case 1). Symptomatic or progressive liver damage from corticosteroid-induced steatohepatitis, on the other hand, is rare. Furthermore, rather than causing nonalcoholic fatty liver disease from the start, corticosteroids can exacerbate the condition. The deterioration could be due to glucocorticoids’ direct effects on insulin resistance or fatty acid metabolism, or it could be due to weight gain, which is normal with long-term corticosteroid therapy. Although simple steatosis caused by corticosteroids is easily reversible, steatohepatitis can take a long time to heal after corticosteroids are stopped.

The deterioration of an underlying untreated viral hepatitis is a serious side effect of corticosteroid treatment. In chronic hepatitis B, corticosteroids can increase viral replication and serum hepatitis B virus (HBV) DNA levels while lowering serum aminotransferase levels. The underlying liver disease will, however, worsen as viral replication increases. Hepatitis worsens when corticosteroids are eliminated or reduced to physiological levels. As the immune system recovers, hepatitis worsens, and serum aminotransferase levels will rise to 10- to 20-fold higher levels, typically followed by a rapid drop in HBV DNA levels. This flare-up of disease after corticosteroid withdrawal can be dangerous, leading to acute liver failure or a significant worsening of chronic hepatitis, as well as the development of cirrhosis (Case 2). Indeed, even patients in the “inactive carrier states” (as shown by the presence of HBsAg in serum without HBeAg or detectable HBV DNA or any elevation in serum aminotransferase levels) will experience severe reactivation of disease and acute liver failure as a result of a short course of high-dose corticosteroids, such as those used in cancer chemotherapy or the treatment of severe autoimmune conditions) will experience severe reactivation of disease and acute Hepatitis B reactivation may be avoided with prophylactic antiviral treatment during immunosuppression, but even this may not be enough to prevent liver injury.

Corticosteroids tend to exacerbate the course of chronic hepatitis C as well, but not as dramatically as chronic hepatitis B. Hepatitis C virus (HCV) RNA levels increase as a result of corticosteroid treatment, potentially worsening the underlying liver disease. Chronic hepatitis C tends to be more serious and difficult to treat in patients who are undergoing chemotherapy or immunosuppression, and corticosteroids are thought to play a role. In patients with underlying chronic viral hepatitis, corticosteroids should be prevented if at all necessary.

Since corticosteroids are used to treat autoimmune hepatitis, they are more likely to help rather than damage patients with this disorder. The problem occurs when corticosteroids are discontinued, since this may result in a relapse of autoimmune hepatitis, which is often serious and fatal. Importantly, several cases of de novo extreme autoimmune hepatitis have been identified in patients who received a short course or pulse of corticosteroids for another, unrelated disorder (such as asthma or allergic reactions). In these cases, a moderate and subclinical autoimmune hepatitis was possibly present prior to the administration of corticosteroids, and the disease’s suppression was accompanied by immune rebound, resulting in the clinical presentation of the disorder. These patients usually respond well to corticosteroids reintroduced, but they can need long-term, if not lifelong, immunosuppressive therapy afterwards.

Finally, there have been many reports of an acute hepatitis-like liver injury that can be serious and sometimes fatal after a brief, high-dose course of intravenous methylprednisolone, and in which viral hepatitis and autoimmune hepatitis are not explicitly involved (Case 3). The cause of this apparent hepatotoxicity is unknown, but it may be extreme autoimmune hepatitis caused by rapid immunosuppression and subsequent immune reconstitution. Importantly, symptoms and jaundice appear 2 to 6 weeks after stopping methylprednisolone, with a standard hepatocellular pattern of serum enzyme elevations. These episodes are usually symptomatic and can be life-threatening. Autoantibodies may not be present, and immune allergic symptoms are rare. Acute liver failure has occurred in many cases, resulting in death or the need for an immediate liver transplant. In this scenario, restarting corticosteroids may be necessary, but it has not been thoroughly evaluated, and several cases have resolved spontaneously. Reexposure to high dose pulse methylprednisolone causes damage to recur, often more rapidly and seriously.

Abuse with Steroids and How to Get Rid of It

Steroid use to enhance athletic performance is particularly dangerous; users risk having severe health conditions such as chronic hepatitis. Steroid use has the ability to become addictive.

Current views recommend that treatment for steroid use address the underlying causes of the steroid use. This can include:

  • Endocrine therapies restore function in those suffering from hypogonadism and alleviate symptoms of depression.
  • Antidepressants for those whose depression does not respond to endocrine therapies.
  • Pharmacological and psychosocial treatments for patients who are also dependent on opioids, which appear also to be effective in alleviating signs of anabolic steroid dependence.

Call our toll-free helpline at 844-768-1086 if you or anyone you know needs care for steroid abuse. Our certified addiction counsellors will answer your questions about steroid addiction.