Table 1.
Summary of included studies
| Reference no. | Country | Study design | Diagnosis | Treatment approach |
|---|---|---|---|---|
| Psychiatric (n = 12) | ||||
| [87] | USA | CS | Depression | Medical therapy |
| [88] | USA | CR | Substance dependence | Drug treatment programme participation |
| [89] | Canada | CR | Depressed mood with anxiety, paranoia, derealisation | Medical therapy, electroconvulsive treatment |
| [90] | Greece | CR | Mood disorder with manic features | Medical therapy |
| [91] | Germany | CR | Mania | Medical therapy |
| [92] | USA | CR | Borderline personality disorder with antisocial traits | Medical therapy, education about AAS, psychotherapy |
| [93] | India | CR | Substance dependence including opioids and AAS | Medical therapy for AAS and opioid withdrawal, psycho-education and relapse prevention |
| [94] | Ireland | CR | Mixed psychotic disorder | Medical therapy |
| [95] | USA | CR | Acute mania | Medical therapy |
| [96] | UK | CR | Psychosis with low mood | Medical therapy |
| [97] | USA | CR | AAS dependence | Drug treatment programme participation |
| [98] | USA | CR | AAS dependence | Medical therapy |
| Neuroendocrine (n = 11) | ||||
| [99] | Netherlands | CR | Hypogonadotropic hypogonadism | Medical therapy |
| [100] | USA | CR | Hypogonadism | Medical therapy |
| [101] | Malaysia | CR | Complete azoospermia | Medical therapy |
| [102] | UK | CR | Severe hypogonadotropic hypogonadism | Medical therapy |
| [103] | UK | CS | Azoospermia | Advice to discontinue AAS |
| [104] | USA | CR | Impotence—reduced testicular volume on both sides and gynaecomastia on both sides | Medical therapy |
| [105] | USA | CR | Azoospermia | Discontinuation of all medications; medical therapy |
| [106] | USA | RCR | Azoospermia | AAS cessation and medical therapy |
| [107] | Italy | CR | Hypogonadotropic hypogonadism | Medical therapy following AAS discontinuation |
| [108] | USA | CS | Hypogonadism | Medical therapy |
| [109] | USA | CR | Azoospermia | Medical therapy |
| Hepatic (n = 25) | ||||
| [110] | USA | CR | Tumour haemorrhage in liver. On second presentation: tender hepatomegaly and haemorrhage, tachycardia | Surgery; instruction to discontinue AAS |
| [111] | Mexico | CR | Liver toxicity, cholestasis | Medical therapy; AAS discontinued |
| [112] | USA | CS | Hepatotoxicity | Medical therapy |
| [113] | USA | CR | Liver toxicity | Medical therapy |
| [114] | USA | CS | Hepatotoxicity. In one case, patient suffered from renal failure. | Medical therapy |
| [115] | Spain | CS | 1) Hyperechogenic lesions in the liver; 2) Acute renal failure, muscular damage, metabolic alkalosis and hypernatraemia | 1) Instruction to discontinue AAS; inclusion in liver transplantation program; 2) Patient received haemodialysis; instruction to discontinue AAS. |
| [116] | UK | CR | Hepatic rupture with cardiovascular collapse, sepsis and acute renal failure | Resuscitation, surgery |
| [117] | Germany | CR | Hepatocellular carcinoma. Liver was enormously enlarged | Chemoembolization was declined by patient who was recommended for transplantation |
| [118] | Australia | CR | Hepatocellular carcinoma | Surgery |
| [119] | Lebanon | CR | Liver injury resulting in prolonged cholestasis and acute kidney injury | Advice to discontinue AAS, medical therapy, plasma exchange. Patient refused renal biopsy. |
| [120] | China | CR | Dilated cardiomyopathy and acute hepatic injury | Medical therapy |
| [121] | Poland | CR | Severe intrahepatic cholestasis that developed to severe liver failure | Medical therapy |
| [122] | UK | CS | Cholestasis | Medical therapy |
| [123] | Spain | CR | Severe cholestatic jaundice | Unclear |
| [124] | USA | CS | Severe hepatotoxicity, cholestasis | Medical therapy |
| [125] | Netherlands | CR | Mild jaundice; cholestatic hepatitis identified through liver biopsy | Medical therapy |
| [126] | UK | CR | Three grade II oesophageal varices | Blood transfusion and sclerotherapy |
| [127] | Australia | CR | Intrahepatic cholestasis | Medical therapy |
| [128] | USA | CR | Severe cholestasis and renal failure. Re-admitted with pruritus | Medical therapy |
| [129] | Spain | CR | Hepatic rupture, liver failure. Hematoma of the liver | Surgery |
| [130] | USA | CR | Acute, nonobstructive, intrahepatic cholestatic hepatitis | Medical therapy; advice to avoid other medications |
| [131] | USA | CR | Severe jaundice, bile acid nephropathy | Medical therapy, blood transfusion, AAS discontinued |
| [132] | Spain | CS | Severe cholestasis, hepatotoxicity | Medical therapy followed by MARS therapy |
| [133] | Brazil | CR | Giant hepatic adenoma | Surgery |
| [134] | Germany | CR | Hepatocellular carcinoma | Surgery |
| Kidney (n = 6) | ||||
| [135] | USA | CR | Initial diagnosis of hepatic adenomatosis (2004). On third admission, diagnosed with chronic kidney disease and coronary artery disease (2013) | Advice given to discontinue AAS initially. Surgery at later presentation. |
| [136] | Spain | CR | Severe acute kidney failure with high blood pressure, anaemia and thrombocytopenia | Medical therapy |
| [137] | Iran | CR | Acute renal failure; muscle injury and rhabdomyolysis | Medical therapy |
| [138] | Brazil | CS | Acute kidney injury in both cases | Medical therapy. |
| [139] | USA | CR | Recurrent renal infarction | Medical therapy, AAS counselling |
| [140] | Lebanon | CR | Acute pancreatitis, acute renal failure and hypercalcemia. | Medical therapy |
| Cardiovascular (n = 26) | ||||
| [141] | Japan | CR | Cardioembolic stroke | Medical therapy, AAS use discontinued |
| [142] | Sweden | CR | Intraparenchymal haemorrhage in right parietal lobe; right cortical venous thrombosis | Anticoagulation therapy |
| [143] | UK | CR | Acute myocardial infarction | Surgery |
| [144] | Egypt | CR | Severe toxic cardiomyopathy. | Medical therapy |
| [145] | Canada | CR | Cardiomyopathy | Incubation, medical therapy, resuscitation, dialysis and device implantation, addiction counselling referral |
| [146] | Argentina | CR | Posterior territory ischemic stroke. | Intubation and ventilation; rehabilitation |
| [147] | Sweden | CR | Severe hypertension | Aggressive treatment with intravenous drugs; AAS cessation |
| [148] | Turkey | CR | Acute coronary syndrome | Medical therapy |
| [149] | Sweden | CS |
i) Occlusion of all major arteries of the leg. ii) Arterial thrombosis: |
i) Surgery ii) Thrombolysis attempted with no improvement. Surgery performed. |
| [150] | Canada | CR | Stroke. Upon readmission 3 years later, diffused distal arterial thrombosis | Medical therapy |
| [151] | Kuwait | CR | Cardiomyopathy, stroke and peripheral vascular disease | Medical therapy |
| [152] | Portugal | CR | Severe toxic cardiomyopathy. | Medical therapy |
| [153] | USA | CR | Myocardial infarction | Medical therapy |
| [154] | Turkey | CR | Myocardial infarction | Medical therapy |
| [155] | Greece | CR | Myocardial infarction | Medical therapy |
| [156] | USA | CR | Acute myocardial infarction and polycythaemia | Surgery, medical therapy, phlebotomy. |
| [157] | Portugal | CR | Myocardial infarction | Medical therapy. |
| [158] | Turkey | CR | Acute inferior myocardial infarction, renal infarction | Medical therapy, surgery |
| [159] | USA | CR | Acute myocardial infarction | Medical therapy, rehabilitation |
| [160] | USA | CR | Myocardial infarction | Medical therapy |
| [161] | Australia | CR | Persistent atrial fibrillation | Electrical cardioversion, medical therapy. |
| [162] | Germany | CR | Severe coronary heart disease | Surgery, medical therapy |
| [163] | UK | CR | Coronary thrombus | Medical therapy |
| [164] | USA | CR | Cardiomyopathy, severe systolic dysfunction and Class IV heart failure. | Medical therapy and device implementation until discharge. |
| [165] | USA | CR | Cardiomyopathy, acute systolic heart failure. | Medical therapy, instruction not to use AAS. |
| [166] | Finland | CS | Cardiac hypertrophy | Surgery, medical therapy. In one case, no treatment was reported |
| Musculoskeletal (n = 13) | ||||
| [167] | USA | CR | Tear in the midsubstance of the triceps tendon. | Surgery, immobilisation |
| [168] | Israel | CR | Massive rhabdomyolysis | Medical therapy |
| [169] | Ireland | CR | Quadriceps tendon rupture, patella tendon rupture, distal femur fracture, patella dislocation in both legs | Surgery, immobilisation, physiotherapy |
| [170] | Iran | CR | Quadriceps tendon rupture in both knees and partial rupture of triceps tendon. | Surgery, immobilisation, physiotherapy |
| [171] | UK | CR | Bilateral rupture of the quadriceps tendon | Surgery, immobilisation |
| [172] | Denmark | CR | Complete rupture of the extensor pollicis longus tendon. | Surgery, immobilisation |
| [173] | Finland | CR | Complete bilateral quadriceps tendon rupture in both legs | Surgery, immobilisation |
| [174] | UK | CR | Rupture of both quadriceps tendons | Surgery, immobilisation, physiotherapy |
| [175] | Finland | CR | Bilateral distal biceps tendon avulsions | Surgery, immobilisation, physiotherapy |
| [176] | UK | CR | Complete rupture of the anterior cruciate ligament | Physiotherapy |
| [177] | UK | CR | Rhabdomyolysis. Initially diagnosed with musculoskeletal pain. | Medical therapy |
| [178] | UK | CR | Bilateral simultaneous traumatic upper arm compartment syndromes | Surgery |
| [179] | Italy | CR | Complete tear of quadriceps tendon | Surgery, immobilisation, rehabilitation |
| Infectious (n = 7) | ||||
| [180] | USA | CR | Abscess. | Medical therapy; AAS counselling |
| [181] | Israel | CR | Full thickness skin and subcutaneous tissue necrosis | Surgery |
| [182] | USA | CR | Pyomyositis | Medical therapy, surgery |
| [183] | UK | CS | Injection injury | Surgery, medical therapy |
| [184] | Turkey | CR | Spontaneous corpus cavernosum abscess | Surgery |
| [185] | UK | CR | Necrotizing myositis | Surgery, medical therapy |
| [186] | UK | CR | Abscess | Surgery, medical therapy |
| Other (n = 8) | ||||
| [187] | UK | CR | Chronic laryngitis | Medical therapy followed by laser treatments |
| [188] | UK | CR | Hypokalaemia and metabolic alkalosis. | Fluid provision |
| [189] | UK | CR | Abnormal lipid profile | Advice to stop using AAS |
| [190] | UK | CR | Acute respiratory distress syndrome | Intubation and ventilation; rehabilitation. |
| [191] | USA | CR | Multiple organ dysfunction syndrome, acute kidney injury and refractory supraventricular tachycardia | Resuscitation, medical therapy, ventilation, haemodialysis and electrical cardioversion for different symptoms. |
| [192] | USA | CR | New onset of diabetes | Medical therapy, AAS advice |
| [193] | Lebanon | CS | Spontaneous subdural haematoma | Surgery |
| [194] | UK | CR | Bilateral internal laryngocoeles | Medical therapy |
CR case report, CS case series, RCR retrospective chart review