Anabolic Steroid Use for Weight and Strength Gain in Critically Ill Patients: A Case Series and Review of the Literature

Anstey, Matthew; Desai, Seema S.; Torre, Luke E; Wibrow, Bradley; Seet, Jason; Osnain, Emma

doi:10.1155/2018/4545623

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…Combined with structured exercise, this approach has shown clinical benefit [ 37 , 38 ]. A case series describes the potential role and benefit of nandrolone (an injectable anabolic steroid) for weight gain and ICU-related myopathy for patients in the recovery phase of critical illness [ 39 ]. While the combination of an anabolic agent with early exercise and adequate nutrition in the ICU is likely the key to optimize muscle strength and functional outcomes for recovering critically ill patients [ 36 ], no large randomized controlled trials have yet led to guidelines addressing anabolic agent supplementation.…”

Section: Discussionmentioning

confidence: 99%

A Screening Tool to Detect Chronic Critically Ill Cardiac Surgery Patients at Risk for Low Levels of Testosterone and Somatomedin C: A Prospective Observational Pilot Study

Ward¹,

Boorman²,

Afshar³

et al. 2021

Cureus

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Objective The neuroendocrine response to critical illness is dichotomous as it is adaptive during the acute phase then transitions to maladaptive as critical illness becomes prolonged in 25-30% of patients. Presently, monitoring all critically ill patients for endocrinopathies is not the standard of care. However, given the negative impact on patient prognosis, a need to identify those at risk for endocrinopathies, may exist. Thus, a screening tool to identify endocrinopathies along the somatotroph and gonadal axes in a cardiothoracic surgery population was developed. Methods A prospective observational pilot study was conducted in two cardiothoracic surgery intensive care units (ICU) within a multi-site healthcare system. Total testosterone and somatomedin C levels were obtained from 20 adult patients who remained in the ICU for greater than seven days after cardiothoracic surgery and were tolerating nutrition, had a risk of malnutrition and a mobility score of moderate to dependent assistance. Results Twenty patients were included for descriptive analysis (seven females). Thirteen patients tested low for total testosterone, with males more likely to have a testosterone-related endocrinopathy as compared to females (100% vs. 0 to 43%, p = 0.0072). A higher proportion of low somatomedin C levels was found in females than males (57% vs. 31%); however, the difference was not statistically significant (p = 0.251). Conclusions The screening tool used in this pilot study accurately predicted low total testosterone in all men and reasonably predicted low somatomedin C in a majority of women. However, the ability of the tool to predict low total testosterone in women and low somatomedin C in men is less certain. A gender-specific screening tool might be necessary to predict hormonal deficiencies.

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Section: Discussionmentioning

confidence: 99%

A Screening Tool to Detect Chronic Critically Ill Cardiac Surgery Patients at Risk for Low Levels of Testosterone and Somatomedin C: A Prospective Observational Pilot Study

Ward¹,

Boorman²,

Afshar³

et al. 2021

Cureus

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“…The addition of anabolic steroids in the recovery phase after critical illness patients, assist them to regain their muscle strength with the addition of early mobility programs. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

Novel management of critically induced polyneuropathy in intensive care patients

Ahuja

Selvam

Chander

et al. 2021

Journal of Anaesthesiology Clinical Pharmacology

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There has been tremendous growth in patients requiring critical care with severe infections. During a prolonged stay in the intensive care unit (ICU), patients develop critical illness polyneuropathy (CIP). The early identification of neurological involvement requires special attention during ICU care. We describe two cases who developed complete motor weakness after a prolonged stay in ICU. Patients were successfully managed with pyridostigmine and testosterone hormonal therapy initially and later with pyridostigmine only. The present case series highlights the need for early recognition, assessment, and novel management of CIP in ICU patients. However, the role of nutrition, physiotherapy, and supportive care is equally essential for the successful outcome in these patients.

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“…The dose selection was based on our own previous experience, as well as published data from other patient populations, and duration based on the likelihood of the patients still remaining in hospital for ongoing administration and measurements. [11][12][13] The rst dose was administered while the patient was still in the ICU, but subsequent doses could be given when the patient had gone to the ward. The study drug was only administered if the patient was still in hospital, and thus not all patients received 3 doses.…”

Section: Study Treatmentmentioning

confidence: 99%

“…[10] Testosterone and oxandrolone have been shown to have bene cial effects on muscle catabolism in patients with burns. [11] Small previous studies have suggested nandrolone to be bene cial for patients recovering from critical illness. [12,13] We designed a phase II randomised controlled trial to explore the feasibility, safety and potential bene ts on muscle strength and recovery from critical illness from nandrolone, or placebo.…”

Section: Introductionmentioning

confidence: 99%

The GAINS trial - Growth and Anabolism In Intensive care Survivors

Anstey

Rauniyar

Fitzclarence

et al. 2020

Preprint

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BackgroundTo explore the feasibility, safety and potential benefits from administration of nandrolone to patients in the recovery phase from critical illness weakness.MethodsIn this phase 2 randomized controlled trial, adult critically ill patients admitted for longer than 7 days with significant weakness, received nandrolone ((males 200 mg, females 100 mg) or placebo weekly, up to a total of three doses. Primary outcome measures were improvement in grip strength, medical research council (MRC) muscle strength sum score, and functional activity level (Chelsea critical care assessment tool (CPAx)).Results22 patients were enrolled between September 2017 and May 2019. No significant adverse events were detected. Median grip strength change was non-significantly greater in the nandrolone group (left hand (9.9 vs 4.4, p = 0.190), right (5.8 vs 3.0, p = 0.343)). The discharge CPAx and ICU mobility scores scores were higher in the nandrolone group, although there was no difference in the change in CPAx score (16.4 vs 17.2, p = 0.865). There were no changes in ultrasound detected muscle thickness between groups.ConclusionsIn patients with prolonged critical illness, nandrolone appears to be safe but a larger study, potentially combined with resistance exercise, is needed to definitively address the potential benefits.Trial registration: ANZCTR registration number : ACTRN12616000835448. Registered 27/6/2016.https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370920

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Anabolic Steroid Use for Weight and Strength Gain in Critically Ill Patients: A Case Series and Review of the Literature

Cited by 10 publications

References 27 publications

A Screening Tool to Detect Chronic Critically Ill Cardiac Surgery Patients at Risk for Low Levels of Testosterone and Somatomedin C: A Prospective Observational Pilot Study

A Screening Tool to Detect Chronic Critically Ill Cardiac Surgery Patients at Risk for Low Levels of Testosterone and Somatomedin C: A Prospective Observational Pilot Study

Novel management of critically induced polyneuropathy in intensive care patients

The GAINS trial - Growth and Anabolism In Intensive care Survivors

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