A very typical case of severe cholestasis due to anabolic steroid use. Because the steroids were being used without medical supervision, the dose and actual duration of use of each preparation was unclear, but cholestasis usually arises within 4 to 12 weeks of starting a C-17 alkylated androgenic steroid. The jaundice can be severe and prolonged and accompanied by severe pruritus and marked weight loss. The serum enzymes are typically minimally elevated except for a short period immediately after stopping therapy. The pattern of enzyme elevations can be hepatocellular, cholestatic or mixed. Liver biopsy shows a “bland” cholestasis with minimal inflammation and hepatocellular necrosis. Ma Huang has also been implicated in cases of drug induced liver injury, but is associated with an acute hepatocellular pattern of injury.
Oxymetholone (also known as anapolon or anadrol) is a very drastic synthetic steroid, 17-alpha-alkylated modification of dihydrotestosterone. It was developed for the treatment of osteoporosis and anaemia, as well as to stimulate muscle gain in malnourished and debilitated patients. Oxymetholone has been approved by the American Food and Drug Administration (FDA) for use in humans. Later there where created non-steroidal drugs that effectively could treat anaemia and osteoporosis; because of this anapolon lost his popularity and by 1993 Syntex decided to cease the production of the drug, as well as other manufacturers did.