Multiple hepatocellular adenomas associated with long-term administration of androgenic steroids for aplastic anemia: A case report and literature review.

Abstract

INTRODUCTION:

Anabolic steroids are widely administered to patients with aplastic anemia (AA) and are associated with numerous medical complications. To assist with future diagnoses, we report about a young boy with multiple hepatocellular adenomas (HAs) induced by long-term use of anabolic androgenic steroids (AAS) for AA and present a related literature review.

PATIENT CONCERN:

A 15-year-old boy who was diagnosed with AA in 2011 had been treated with stanozolol (6 mg per day) and ciclosporin A (120-150 mg per day) for almost 4 years. He presented with epigastric pain and fever, and abdominal computed tomography showed a lesion of heterogenous density measuring 13.5 × 13.0 × 8.0 cm in the left hepatic lobe, which was initially misdiagnosed as a liver abscess.

DIAGNOSIS:

The patient went into hemorrhagic shock twice after invasive manipulation that aimed at diagnosis and was finally diagnosed with HA using fine needle aspiration.

INTERVENTIONS:

The patient discontinued AAS and only reserved ciclosporin A for AA treatment.

OUTCOMES:

Follow-up abdominal computed tomography performed 4 years after AAS discontinuation showed obvious regression of the hepatic lesions.

CONCLUSION:

It is of great importance for hematologists to completely understand that the long-term use of AAS may cause HA, which carries a great risk of hemorrhage and malignant transformation.

• Authors: Lixia Wang, Cong Wang, Wei Li, Fanyang Meng, Yuying Li, Hongqiong Fan, Yanhua Zhou, Gnana Bharathi, Sujun Gao, Yan Yang
• Journal: Medicine (Medicine (Baltimore)) Vol. 99 Issue 28 Pg. e20829 (Jul 10 2020) ISSN: 1536-5964 [Electronic] United States
• PMID: 32664077 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Immunosuppressive Agents
• Testosterone Congeners
• Stanozolol
• Cyclosporine

Topics

• Abdominal Pain (etiology)
• Adenoma, Liver Cell (chemically induced, pathology)
• Adolescent
• Adult
• Aftercare
• Aged
• Anemia, Aplastic (complications, drug therapy)
• Biopsy, Fine-Needle (methods)
• Cyclosporine (therapeutic use)
• Diagnostic Errors
• Female
• Fever (etiology)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Liver Abscess (diagnostic imaging)
• Liver Neoplasms (diagnostic imaging, pathology)
• Male
• Middle Aged
• Shock, Hemorrhagic (diagnosis, etiology)
• Stanozolol (adverse effects, therapeutic use)
• Testosterone Congeners (adverse effects, therapeutic use)
• Tomography, X-Ray Computed (methods)