Bodybuilder

A patient is admitted for incision and drainage of buttock abscesses. He is a 39-year-old

professional bodybuilder who was competing in a national bodybuilding tournament

four days ago. He is 185cm tall and weighs 100 kg. He admits that his abscesses are due

to long-term abuse of injected anabolic steroids administered into the buttock.

Compared to a healthy male matched for age, height and weight who takes moderate

exercise for 30 minutes three times a week, which of the following is LEAST LIKELY to

be found in this patient?

a) A higher risk of developing atrial fibrillation

b) A higher anaerobic threshold

c) A higher risk of pressure sores

d) A faster emergence from volatile anaesthesia

e) A higher risk of venous thromboembolism

Answer: b

Explanation

From the history, there are two key points that need to be flagged up about the patient.

First, he is a competition-prepared bodybuilder and, second, he is on parenteral

anabolic steroids. Steroid abuse is common with a conservative estimate of 10 to 15% of

regular gym attendees using anabolic steroids. Competitive bodybuilders train hard on

high-calorie, protein-rich, low-fat diets in between competitions then go on to very lowcalorie

diets in the period leading up to competition. They reduce their body fat down to as

low as 2 to 4% to improvemuscle definition. At this level even the fat pads in their feet are

reduced in size, so they are particularly at risk of pressure sores. In this condition, body

builders are easily fatigued and so would perform lesswell than the comparisonmalewho

exercises regularly. The low body fat would also produce a faster emergence from volatile

anaesthesia. Because of the illegal nature of steroid use, there are not and are never likely to

be any randomised controlled trials looking at their side effects in the bodybuilding

community. Information from case reports and series would suggest that bodybuilding

and steroidabuse puts the patient at riskofawide range of side effects.Thesemayinclude

palpitations, arrhythmias, left ventricular hypertrophy, hypertension, clotting abnormalities,

hypercholesterolaemia, and both functional and structural abnormalities of the liver.

Reference

Kam PC, Yarrow M. Anabolic steroid abuse: physiological and anaesthetic considerations.

Anaesthesia 2005; 60(7): 685–92.