Category: Steroids

 Amid growing concerns about sports "doping," researchers in Indiana and China report development of a faster and more efficient method for detecting the presence of illegal anabolic steroids in urine.

Their new method, which takes only a few seconds and involves no time-consuming sample preparation, will be described in  Analytical Chemistry.

The study notes that use of banned substances by professional athletes to build muscle and gain a competitive advantage is a growing problem in sports such as track and field, baseball, football and cycling. Although effective methods exist for detecting the presence of illegal steroids in urine, current methods are time-consuming and involve cumbersome preparation steps.

Zheng Ouyang, R. Graham Cooks, and colleagues developed a new steroid-testing method that combines two state-of-the-art testing techniques called desorption electrospray ionization (DESI) and tandem mass spectrometry. In laboratory studies, the researchers used it to analyze fresh urine samples for the presence of tiny amounts of seven different anabolic steroids. The new method accurately identified the steroids in only a few seconds using only a single drop of urine, they say.

Reference:  "Rapid Screening of Anabolic Steroids in Urine by Reactive Desorption Electrospray Ionization" Analytical Chemistry, November 1, 2007.

The majority of non-medical anabolic-androgenic steroid (AAS) users are not cheating athletes or risk-taking teenagers. According to a recent survey, containing the largest sample to date the typical male user is about 30 years old, well-educated, and earning an above-average income in a white-collar occupation. The majority did not use steroids during adolescence and were not motivated by athletic competition or sports performance.

The study, conducted by a collaboration of researchers from around the country coordinated by Jason Cohen, Psy.D. candidate, used a web-based survey of nearly 2,000 US males. Whereas athletes are tempted to take anabolic steroids to improve sports performance, the study suggests that physical self-improvement motivates the unrecognized majority of non-medical AAS users who particularly want to increase muscle mass, strength, and physical attractiveness. Other significant but less highly ranked factors included increased confidence, decreased fat, improved mood and attraction of sexual partners.

Although often considered similar to abusers of narcotics and other illicit drugs (e.g., heroin or cocaine), non-medical AAS users are remarkably different. These users follow carefully planned drug regimens in conjunction with a healthy diet, ancillary drugs and exercise. As opposed to the spontaneous and haphazard approach seen in abusers of psychotropic drugs, everything is strategically planned to maximize benefits and minimize harm. "This is simply not a style or pattern of use we typically see when we examine substance abuse" said Jack Darkes, Ph.D., one of the authors. "The notions of spontaneous drug seeking and loss of control do not apply to the vast majority of AAS users," added co-author Daniel Gwartney, M.D.

"These findings question commonly held views of typical AAS users and their underlying motivations," said Rick Collins, one of the study's authors. "The focus on 'cheating' athletes and at risk youth has led to irrelevant policy as it relates to the predominant group of non-medical AAS users. The vast majority of AAS users are not athletes and hence, are not likely to view themselves as cheaters. The targeting of athletes through drug testing and other adolescent or sports-based interventions has no bearing on non-competitive adult users."

The study concludes that these AAS users are a driven and ambitious group dedicated to gym attendance, diet, occupational goals and educational attainment. "The users we surveyed consider that they are using directed drug technology as one part of a strategy for physical self-improvement within a health-centered lifestyle," said Collins. "Effective public policy should begin by accurately identifying who's using steroids and why. We hope our research – the largest adult survey of non-medical AAS use we know of – is a significant step forward in that direction."

Article: A League of Their Own: Demographics, Motivations and Patterns of Use of 1,955 Male Adult Non-Medical Anabolic Steroid Users in the United States, Jason Cohen, Rick Collins, Jack Darkes and Dan Gwartney, Journal of the International Society of Sports Nutrition

The use of steroid medication to treat bronchiolitis — a common viral lower respiratory infection in infants — does not prevent hospitalization or improve their respiratory symptoms, according to a study published in the July 26 issue of The New England Journal of Medicine. The findings by the Pediatric Emergency Care Applied Research Network (PECARN) resolve controversy from prior research and are expected to help guide treatment for the most common cause of infant hospitalization.

The study compared hospitalization rates for 600 children between the ages of 2 months and 12 months who visited emergency rooms with moderate-to-severe bronchiolitis. Patients were treated with either a dose of dexamethasone (a glucocorticoid form of steroid medication) or a placebo and evaluated after one hour, and again at four hours.

The hospital admission rate for both groups was identical at nearly 40 percent. Both groups improved during treatment, but the placebo group did as well as the group treated with active medication. The study was conducted in the emergency departments at 20 hospitals across the United States between November and April during a three-year period. Bronchiolitis is most common during the winter months.

"We learned that a commonly used treatment doesn't work," said Howard M. Corneli, M.D., professor of pediatrics at the University of Utah and the principal investigator on the study. "Now that we've demonstrated glucocorticoids aren't effective in treating bronchiolitis, we can focus our efforts on finding better treatments and better preventive strategies."

Bronchiolitis is the leading cause of hospitalization for infants in the United States and accounts for more than 100,000 admissions each year. Hospital charges associated with the disease exceed $700 million annually.

Corneli says the best solution to the problem of bronchiolitis might be to find a vaccine for the Respiratory Syncytial Virus (RSV) — the most common cause of bronchiolitis. RSV accounts for 50 to 80 percent of all bronchiolitis cases.

Bronchiolitis infections begin most frequently with a fever, runny nose, coughing, and wheezing. Most children recover from the illness in eight to 15 days. The majority of children hospitalized for bronchiolitis infections are under 6 months old. Although many children with bronchiolitis have mild infections, and most don't need hospitalization, children born prematurely or who suffer from heart and lung disease are most at risk for complications.

"This study provides solid evidence to guide treatment of this common illness," said Joseph Zorc, M.D., an emergency physician at The Children's Hospital of Philadelphia (CHOP) and a lead co-investigator. "Current recommendations suggest that simple supportive care is the best available treatment for bronchiolitis. This study will help resolve some of the uncertainty for physicians and families and prevent unnecessary side effects."

Both physicians note that glucocorticoid medications still play an important role in other respiratory illnesses of childhood such as asthma and croup. They point out these medications are not the androgenic steroids sometimes abused by athletes, and that the side effects seen with long-term steroid use are not a risk in the short-course treatments used for croup and asthma attacks.

Nathan Kuppermann, M.D., a professor of emergency medicine and pediatrics at the University of California, Davis, chair of the PECARN network's steering committee, and the senior investigator of the study, stated, "this study also demonstrates the power of a research network like PECARN to resolve the difficult-to-answer questions in our field. The network is able to generate definitive research findings because of its size and substantial infrastructure to conduct high-quality work."

The other lead co-investigators were Prashant Mahajan, M.D., an emergency medicine physician at the Children's Hospital of Michigan, and Kathy Shaw, M.D., chief of emergency medicine at CHOP.

 Although steroids are the most widely used treatment for sudden hearing loss, little scientific evidence supports their use or that of any other therapies for this condition, according to a systematic review and meta-analysis both published in the June issue of Archives of Otolaryngology–Head & Neck Surgery.

Sudden sensorineural hearing loss is acute hearing impairment involving loss of at least 30 decibels of hearing over at least three test frequencies occurring within three days, according to background information in the article. The condition affects about five to 20 of every 100,000 individuals yearly. Treatment varies widely and includes antiviral medications, vitamins, minerals, herbs, hyperbaric oxygen and agents that dilute the blood. "In addition, some otolaryngologists choose not to treat sudden sensorineural hearing loss at all, citing spontaneous recovery rates of 32 percent to 70 percent," the authors write. "However, the most common approach to treatment of sudden sensorineural hearing loss in North America is with systemic steroids, which has been deemed by some authors to be the gold standard of treatment."

Anne Elizabeth Conlin, B.A. & Sc., M.D., of the University of Ottawa, Ontario, and Lorne S. Parnes, M.D., F.R.C.S.C., of the University of Western Ontario, London, Canada, searched for all randomized clinical trials evaluating treatments for sudden hearing loss published between 1966 and 2006.

For the systematic review, 21 trials were identified and evaluated, all of which used measures from hearing tests to define treatment outcomes. "Only two studies used identical criteria to define sudden sensorineural hearing loss," the authors write. "The method of randomization was described in two studies. Validity scores ranged from two to eight (of nine). Positive results were reported favoring systemic steroids, intratympanic [inside the inner ear] steroids, batroxobin, magnesium, vitamin E and hyperbaric oxygen, although there were serious limitations in each study with a positive finding."

This includes the article cited as the landmark study for the use of steroids, which was not described as a randomized trial and therefore may have produced exaggerated treatment effects, the authors note. The authors suggest that this study also used inconsistent doses of steroids and did not measure outcomes at the same time for all participants. "The study therefore does not inform the otolaryngologist of what dose of steroids to use, nor at what time after treatment to expect improvement," the authors write.

"To our knowledge, no valid randomized controlled trial exists to determine effective treatment of sudden sensorineural hearing loss," they conclude. "Systemic steroids cannot be considered the gold standard of treatment of sudden sensorineural hearing loss, given the severe limitations of the landmark study supporting their use."

For the meta-analysis, data from the same trials were combined when they covered the same therapies. Five trials were eligible for the analysis. "Pooling of data from two randomized clinical trials that compared steroids with placebo showed no difference between treatment groups," the authors write. "No difference existed between patients treated with antiviral plus steroid therapy vs. placebo plus steroid therapy. Finally, there was no difference between subjects treated with steroids vs. subjects treated with any other active treatment."

Treating sudden hearing loss is difficult because its cause is often unknown, the authors note. However, it is still important to identify the therapy that most benefits the patient. "At present, sudden sensorineural hearing loss remains a medical emergency without a scientific understanding of its cause or a rational approach to its treatment," they conclude.

Reference: Arch Otolaryngol Head Neck Surg. 2007;133:573-581 and 582-586.

Two years or more of oral steroid treatment decreases the risk of rheumatoid arthritis (RA) related lymphoma, according to data presented today at EULAR 2007, the Annual European Congress of Rheumatology, in Barcelona, Spain. Furthermore, these effects were found regardless of when in the course of the disease the steroids were first administered. However, these beneficial effects were not observed if the steroids were taken for less than a two year period.

Study author Dr Eva Baecklund of Uppsala University Hospital, Sweden, said of the results, "The pros and cons of corticosteroid treatment in rheumatoid arthritis have been a subject of much debate and long term steroid treatment is often limited as a result of concerns about various side effects. What our data show is a new aspect of steroid treatment. Patients with severe rheumatoid arthritis are at increased risk for malignant lymphomas (cancer in the immune system), but long term steroid treatment may decrease this risk."

In individuals treated with steroids for over two years, the risk of rheumatoid arthritis-associated lymphomas was significantly reduced (relative risk 0.4; 0.2-0.7), whilst less than two years of steroids yielded no such reduced risk (relative risk 0.9; 0.5-1.5). The most pronounced protective steroidal effect was observed in the diffuse large B-cell lymphoma subtype – the type of lymphoma most commonly associated with RA 1,2,3 with an odds ratio of 0.7 (0.4-1.0).

The study involved 378 patients with rheumatoid arthritis-associated lymphoma identified from the Swedish Hospital Register and the Cancer Register compared with 378 individually matched RA controls, i.e. patients with RA but without lymphoma.

Using data on steroid treatment type and duration along with inflammatory load collected from cases and controls, information on lymphoma type (where observed) was also collected. The lymphoma tissues were obtained from the pathology laboratories and were reclassified according to the most recent lymphoma classification, the World Health Organization classification.

Interestingly, researchers also compiled information on the duration of RA at initiation of steroid treatment. In this study there was no correlation observed between protective function and length of RA at onset of steroidal treatment. The protective effect was identical in those starting steroid treatment the first five years after onset of RA and in those starting later (relative risk 0.6; 0.3-0.9). Steroid treatment outcome was not associated with the presence of the Epstein-Barr virus in the lymphomas.

These results build on those of a previously published study that reported that orally prescribed and intra-articular (administered within the joint or joint cavity) steroids protect the individual from the development of malignant (actively cancerous) lymphomas in a dose responsive manner.¹

Reference:

1. Baecklund E, et al. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum 2006;54:692-701.

— Researchers from the Division of Health Promotion & Sports Medicine at Oregon Health & Science University have found steroid use among teen girls is not limited to athletes and often goes hand in hand with other unhealthy choices, including smoking and taking diet pills. The study will be published in the June issue of Archives of Pediatrics & Adolescent Medicine, a JAMA/Archives journal.

Diane Elliot, M.D., professor of medicine (health promotion and sports medicine), OHSU School of Medicine, and colleagues analyzed findings from the Center for Disease Control's Youth Risk Behavior Survey of 7,544 ninth- through 12th-grade girls from around the country. The questionnaire asked about sports participation, anabolic steroid and drug use, and other illegal or unhealthy behaviors. Approximately 5 percent of participants reported prior or ongoing anabolic steroid use.

In addition to greater substance use, young female steroid users were more likely to have had sexual intercourse before age 13; have been pregnant; drink and drive or have ridden with a drinking driver; carry a weapon; have been in a fight on school property; have feelings of sadness or hopelessness almost every day for at least two weeks; and have attempted suicide. Those reporting anabolic steroid use were less likely to participate in team athletics.

Overall, more than two-thirds of those surveyed reported trying to change their weight. Girls who used steroids were more likely try extreme weight-loss techniques, such as vomiting and laxative use.

Adolescent girls reporting anabolic steroid use had significantly more other health-harming behaviors, Elliot explained, "They were much more likely to use other unhealthy substances, including cigarettes, alcohol, marijuana and cocaine."

"Across all grades, these seem to be troubled adolescents with co-occurring health-compromising activities in the domains of substance use, sexual behavior, violence and mental health," Elliot said. "Anabolic steroid use is a marker for high-risk girls. High-risk young women have received less attention than young men, perhaps reflecting that their actions are less socially, albeit more personally, destructive. Further study is needed to develop effective interventions for these young women."

Steroid use among teen girls is not limited to those involved in competitive athletics and is associated with a cluster of other health-harming behaviors, including smoking and taking diet pills, according to results of a national survey published in the June issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

In 2004, the Centers for Disease Control and Prevention reported that 7 percent of ninth-grade girls reported ever using anabolic steroids, according to background information in the article. During the 1990s, three national surveys indicated dramatic increases in the prevalence of teen girls using steroids. Previous analyses of female steroid use have focused on older women and found an association with competitive athletics and bodybuilding.

Diane L. Elliot, M.D., of the Oregon Health & Science University, Portland, and colleagues assessed anabolic steroid use among teen girls using a nationally representative sample of U.S. high schools completed in 2003. A total of 7,544 female students in grades nine through 12 completed the survey, which included questions about sports participation as well as steroids, ecstasy use and other illegal or unhealthy behaviors.

A total of 5.3 percent of the participants reported prior or ongoing steroid use. "Participating in team sports was negatively related to anabolic steroid use, such that those who were members of sports teams were less likely to self-report prior or ongoing anabolic steroid use," the authors write.

"Adolescent girls reporting anabolic steroid use had significantly more other health-harming behaviors," they continue. "They were much more likely to use other unhealthy substances, including past 30-day use of cigarettes, alcohol, marijuana and cocaine."

Young female steroid users were also more likely to:

• have had sexual intercourse before age 13
• have been pregnant
• drink and drive or have ridden with a drinking driver
• carry a weapon
• have been in a fight on school property in the past year
• have feelings of sadness or hopelessness almost every day for at least two weeks
• have attempted suicide

More than two-thirds of the teen girls surveyed reported trying to change their weight. However, those who used steroids were more likely to turn to extreme weight-loss techniques, including vomiting and laxative use. "Anabolic steroids are body-shaping agents and cause a loss in body fat and an increase in lean tissue; therefore, their association with unhealthy weight loss practices was not surprising," the authors write.

The findings highlight important associations among girls who use steroids, the authors conclude. "Across all grades, these seem to be troubled adolescent girls with co-occurring health-compromising activities in the domains of substance use, sexual behavior, violence and mental health," they conclude. "High-risk adolescent girls seem to have received less attention than adolescent boys, perhaps reflecting that their actions are less socially, albeit perhaps more personally, destructive. Anabolic steroid use is another marker for high-risk adolescent girls, and further study is needed to develop effective interventions for this population."

Arch Pediatr Adolesc Med. 2007;161:572-577.

Some children may not be able to keep their asthma under control even if they consistently report using inhaled corticosteroids, a mainstay of asthma treatment, suggests a new study.

The study of 914 children with mild to moderate asthma found that over a one-year period, children who reported consistent inhaled steroid use were 20% less likely to report having well-controlled asthma compared with those not using any inhaled steroids. This finding held even when the severity of the children's asthma was taken into account.

"There may be several reasons for our findings; It is possible that some children are genetically less responsive to steroids," says researcher Gregory Sawicki, M.D. of Children's Hospital in Boston. "In addition to issues of medication adherence and inability to completely control for differences in underlying asthma, severity can never be completely ruled out."

Several studies of adults with asthma have suggested that even rigorous use of inhaled steroids doesn't lead to well controlled asthma in all adults, Dr. Sawicki noted. "But this issue hasn't been looked at closely in children," he said. "Further studies are needed to see what is different about children who don't respond to steroids, to see if there is a way to predict whether a child will respond to inhaled steroids."

Of the 914 children in the study, inhaled steroids were recommended for 435 who had persistent asthma, meaning they had symptoms on a regular basis. Among children who weren't recommended for inhaled steroid treatment, most reported well-controlled asthma. Among those recommended for inhaled steroid treatment, 44% reported consistently using the medicine; 35% said they intermittently used the medicine and 21% said they didn't use it at all.

"The majority of children with mild asthma are less likely to have symptoms as they get older and may not need to be on daily steroids," Dr. Sawicki said. "The flip side is that if a child has poor asthma control, the parents and doctor need to make sure the child is adhering to their inhaled steroid treatment. But variation in response to inhaled steroids, as other medications, is well described."

The data comes from the Child Asthma Management Program Continuation Study (CAMPCS), one of the largest groups of children with mild to moderate asthma in the nation who have been followed over 10 years. "This study gives us a good sense of real-world practice in asthma management," Dr. Sawicki says. "The children's care is not directed by anyone in the study; it's an observation of what goes on when the children's care is directed by their own physicians."

This study was presented at the American Thoracic Society 2007 International Conference, on Wednesday, May 23. "Patterns of Inhaled Steroid (ICS) Use and Asthma Control in Childhood Asthma Management Program Continuation Study" (Session D92; Abstract # 1393)

Boys with Duchenne muscular dystrophy were able to walk on their own for a longer period of time and reduce their risk of scoliosis as a result of receiving daily steroid treatments for several years, according to a study published in the May 8, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology.

Duchenne muscular dystrophy occurs in one in 3,500 boys. Symptoms start in early childhood and rapidly progress with most boys losing the ability to walk between ages nine and 11. There is no cure for the disorder.

For the study, researchers reviewed records of 143 boys seen at the Ohio State University Muscular Dystrophy Clinic in Columbus. Of the group, 75 had been treated with corticosteroids for an average of eight years and the rest of the boys had never been treated or had received a brief dose of steroids.

The study found boys who were treated with daily steroids walked by themselves 3.3 years longer than the untreated boys and had a lower rate of scoliosis, 31 percent compared to 91 percent.

"Previous studies have shown steroids improve strength and function in Duchenne muscular dystrophy, but this is the first study to show the long-term impact and how treated boys are able to walk longer on their own," said study author Wendy King, PT, with the Department of Neurology at Ohio State University Medical Center, and member of the American Academy of Neurology.

However, the study found those boys being treated with daily steroids had an increased risk of vertebral and leg fractures. Vertebral fractures occurred in 32 percent of the boys treated with steroids, whereas there were no fractures reported in the untreated group. Leg fractures were 2.6 times more common in the steroid-treated group. King said this may be due to increased body weight and that the treated boys walked longer than the untreated group.

"The benefits of steroids come at a cost of the side effects, and patients and parents need to weigh the benefits and risk of steroid treatments in order to make an informed decision," said King.

The study is supported by the General Clinical Research Center at Ohio State University and the National Center of Research Resources at the National Institutes of Health.

Participation in sports with real or perceived weight requirements, such as ballet, gymnastics, and wrestling, is strongly associated with unhealthy weight control behaviors and steroid use in teens, according to researchers at the University of Minnesota.

Research published in the March 2007 issue of the Journal of the American Dietetic Association found nearly 6 percent of males between the ages of 12 and 18 who participated in weight-related sports induced vomiting within the week prior to being surveyed, as compared to only 0.9 percent of males who did not participate in weight- related sports. The use of diuretics within the previous year was reported by 4.2 percent of males in a weight-related sport, as opposed to 0.8 percent who did not participate in a weight-related sport.

Steroid use was reported in 6.8 percent of females who reported participating in weight-related sports, compared to 2.3 percent of those that weren't active in a weight-related sport. Vomiting and using laxatives were also more likely in girls who were active in weight-related sports.

"The link between unhealthy weight-control behaviors and weight-related sports, especially in boys, is alarming," said Marla Eisenberg, Sc.D., M.P.H., assistant professor at the University of Minnesota Medical School Department of Pediatrics. "Parents and coaches should emphasize skill and talent instead of weight and body image and educate teens about the negative health effects of steroid use and extreme weight control."

Researchers surveyed over 4,500 middle and high school students from the Minneapolis/St. Paul metro area. The students were asked if they had engaged in self-induced vomiting, used diet pills or laxatives, or used steroids within the previous week and year.

Steroid use in teens peaks at young age, but overall use has not increased

In a separate study, published in the March 2007 issue of Pediatrics, University of Minnesota researchers surveyed the same teen population again five years later. They found that steroid use among teens peaked at 5 percent in middle school boys and girls, but as they grew older, steroid use declined significantly.

"It is encouraging to see that the majority of young people who reported using steroids in 1999 stopped using them as they got older," said Patricia van den Berg, Ph.D., lead author of the study from the University of Minnesota School of Public Health. "But even given this decline, between one and three in 100 teens still reported using steroids within the last year when asked again 5 years later."

Researchers conducted the longitudinal study with more than 2,000 adolescents to examine changes in eating patterns, weight, physical activity, and related factors over five years. Participants completed two surveys, one in 1999 and one in 2004, to determine if there were changes in steroid use.

Overall, 1.7 percent of boys and 1.4 percent of girls between the ages of 15 and 23 reported steroid use in 2004. Those that reported use early on were 4 to 10 times more likely to use later in life.

Boys who reported wanting a larger body in 1999, as well as those who said they used healthy weight-control behaviors, were more likely to take steroids when they were older. In contrast, girls who were heavier, less satisfied with their weight, and who had limited knowledge of healthy eating and exercise habits were more likely to take steroids as they grew older.

The study found no significant change in steroid use overall among teens from 1999-2004. "Our research suggests that the increased media coverage surrounding steroid use among athletes in recent years hasn't led to a huge rise in steroid use in young people," said van den Berg.

Anabolic-androgenic steroids are synthetic derivatives of the male hormone, testosterone. They are typically taken to increase muscle mass and strength for either improved sports performance or enhanced appearance. These steroids have significant negative effects on the body's muscles, bones, heart, reproductive system, liver, and psychological state.