{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T22:51:23Z","timestamp":1761519083105},"reference-count":30,"publisher":"The Endocrine Society","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,12,1]]},"abstract":"\n Context:<\/jats:title>\n The harmful consequences of abuse of performance-enhancing substances (PESs), stimulants, and masking agents among athletes, recreational weight lifters, and physical trainers are common. However, the adverse health outcomes with severe unexpected and dramatic consequences are unrecognized or under-reported at the expense of short-term glory or body-image effects, especially in elite sports.<\/jats:p>\n <\/jats:sec>\n \n Objective:<\/jats:title>\n We report the case of a recreational weight lifter\/physical trainer to help summarize the adverse health consequences and outcomes of polypharmacy among athletes and growing subsets in our population engaged in physical\/fitness training. We show that in addition to the risk inherent to \u201cstacking\u201d of PESs, the users are predisposed to harmful consequences, including risk of exposure to toxic contaminants.<\/jats:p>\n <\/jats:sec>\n \n Design and Setting:<\/jats:title>\n A previously healthy man with chronic use of multiple PESs, stimulants, and masking agents presented to a tertiary-care hospital with jaundice and mild hepatitis with rapid progression into liver and multisystem organ failure. This is followed by a brief overview of the specific toxicity (arsenic) and PESs that contributed to the poor outcome in this case.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Surreptitiously or self-administered cocktails of potential PESs including anabolic agents, emerging classes of GH-releasing peptides, androgen precursors, stimulants, and masking agents could lead to adverse consequences including early mortality, multisystem pathology, unmask\/accelerate malignancy, and expose or predispose users to extreme danger from contaminants. This cautionary case reinforces the need to increase awareness and highlights the challenges that testing agencies, regulators, and clinicians face in the fast-developing licit\/illicit trade of these products.<\/jats:p>\n <\/jats:sec>","DOI":"10.1210\/jc.2013-2310","type":"journal-article","created":{"date-parts":[[2013,11,12]],"date-time":"2013-11-12T04:31:13Z","timestamp":1384230673000},"page":"4613-4618","source":"Crossref","is-referenced-by-count":14,"title":["The Adverse Health Consequences of the Use of Multiple Performance-Enhancing Substances\u2014A Deadly Cocktail"],"prefix":"10.1210","volume":"98","author":[{"given":"Nimalie J.","family":"Perera","sequence":"first","affiliation":[{"name":"Departments of Endocrinology & Metabolism Centre (N.J.P.), NSW 2050, Australia"},{"name":"Clinical Biochemistry (N.J.P.), NSW 2050, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine S.","family":"Steinbeck","sequence":"additional","affiliation":[{"name":"Sydney Medical School (K.S.S., N.S.), University of Sydney, Camperdown, NSW 2006, Australia"},{"name":"Academic Department of Adolescent Medicine (K.S.S.), The Children's Hospital at Westmead, Westmead, NSW 2145, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Shackel","sequence":"additional","affiliation":[{"name":"Gastroenterology (N.S.), Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia"},{"name":"Sydney Medical School (K.S.S., N.S.), University of Sydney, Camperdown, NSW 2006, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","reference":[{"key":"2020071616255100500_B1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1745-6673-2-4","article-title":"Supplement use in sport: is there a potentially dangerous incongruence between rationale and practice","volume":"2","author":"Petr\u00f3czi","year":"2007","journal-title":"J Occup Med Toxicol"},{"issue":"5","key":"2020071616255100500_B2","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/01.jsm.0000180872.22426.bb","article-title":"Anabolic steroid use in weightlifters and bodybuilders: an internet survey of drug utilization","volume":"15","author":"Perry","year":"2005","journal-title":"Clin J Sport Med"},{"issue":"3","key":"2020071616255100500_B3","doi-asserted-by":"crossref","first-page":"329","DOI":"10.3109\/10826084.2011.630225","article-title":"Nonprescription steroids on the internet","volume":"47","author":"Clement","year":"2012","journal-title":"Subst Use Misuse"},{"issue":"2","key":"2020071616255100500_B4","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.drugalcdep.2007.04.004","article-title":"Trends in non-medical use of anabolic steroids by U.S. college students: results from four national surveys","volume":"90","author":"McCabe","year":"2007","journal-title":"Drug Alcohol Depend"},{"key":"2020071616255100500_B5","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1210\/jc.2009-1579","article-title":"Androgen abuse in athletes: detection and consequences","volume":"95","author":"Basaria","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"23","key":"2020071616255100500_B6","doi-asserted-by":"crossref","first-page":"10252","DOI":"10.1021\/ac302034w","article-title":"Metabolism of growth hormone releasing peptides","volume":"84","author":"Thomas","year":"2012","journal-title":"Anal Chem"},{"issue":"2\u20133","key":"2020071616255100500_B7","first-page":"100","article-title":"The use of anabolic androgenic steroids and polypharmacy: a review of the literature","volume":"114","author":"Dodge","year":"2011","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"2020071616255100500_B8","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.yhbeh.2009.09.006","article-title":"Illicit anabolic- androgenic steroid use","volume":"58","author":"Kanayama","year":"2010","journal-title":"Horm Behav"},{"key":"2020071616255100500_B9","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s004140050165","article-title":"Performance enhancing drugs (doping agents) and sudden death\u2013a case report and review of the literature","volume":"111","author":"Hausmann","year":"1998","journal-title":"Int J Legal Med"},{"issue":"7","key":"2020071616255100500_B10","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1210\/jc.2008-0977","article-title":"Testosterone doping: dealing with genetic differences in metabolism and excretion","volume":"93","author":"Bowers","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2020071616255100500_B11","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1038\/sj.ijir.3901366","article-title":"Testosterone replacement therapy for male hypogonadism: part III. 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