@article{ref1,
title="The adverse health consequences of the use of multiple performance-enhancing substances: A deadly cocktail",
journal="Journal of clinical endocrinology and metabolism",
year="2013",
author="Shackel, Nicholas and Steinbeck, Katherine S. and Perera, Nimalie J.",
volume="98",
number="12",
pages="4613-4618",
abstract="Context: 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 under-recognized or under-reported at the expense of short-term glory or body-image effects, especially in elite sports.  OBJECTIVE: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 &quot;stacking&quot; of PESs, the users are predisposed to harmful consequences, including risk of exposure to toxic contaminants.  Design and Setting: 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.  CONCLUSION: Surreptitiously or self-administered cocktails of potential PESs including anabolic substances, emerging classes of GH-releasing peptides or androgen precursors, stimulants, and masking agents could lead to adverse consequences including early mortality, multisystem pathology, and unmasked/accelerated malignancy, and could even expose/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.<p /> <p>Language: en</p>",
language="en",
issn="0021-972X",
doi="10.1210/jc.2013-2310",
url="http://dx.doi.org/10.1210/jc.2013-2310"
}