British researchers said they have identified in a bodybuilder the first case of frank diabetes triggered by misuse of human growth hormone, suggesting that physicians need to check for hyperglycemia in athletes who use the substances and remind them of their dangers.
Researchers at University Hospital Coventry and Warwick Hospital (England) said the patient, a 36-year-old man who admitted to using anabolic steroids for 15 years and growth hormone for 3 years, presented to a hospital emergency department with impaired liver function and hyperglycemia.
His blood glucose levels were 30.2 mmol/L, and he had mild hepatomegaly.
He had lost 88 pounds and now weighed 198 pounds; the weight loss was associated with polyuria (12 L/day), polydipsia, and polyphagia. There also was evidence of acute hepatitis.
During a 5-day hospital stay, the patient's biochemistry was stabilized with insulin and intravenous fluids. He was then discharged.
The patient stopped using steroids and growth hormone, and at a 6-weeks' follow-up his hyperglycemia had disappeared, confirmed by a glucose tolerance test.
“Treatment of these particular patients requires us to know their mind set, and to know what motivates them,” wrote the researchers, Dr. James Young and Dr. Aresh Anwar. “This will allow us to identify, and therefore educate, them with regard to the potential pitfalls of using performance-enhancing drugs.
“We would recommend checking for hyperglycemia in those taking supraphysiological doses of growth hormone,” they wrote. “Moreover, in those cases where diabetes resolves, we would recommend long-term follow-up for diabetes mellitus screening.”
Use of human growth hormone, which is undetectable in many assays used to screen for performance-enhancing drugs, is on the rise among athletes and bodybuilders, and is widely available through the Internet, they wrote.
Athletes who use growth hormones self-medicate with insulin, although the misuse of insulin may be intended as a performance-enhancing drug, not necessarily to counteract the insulin resistance that develops with use of growth hormone, according to the researchers.
It also is not clear whether the misuse of human growth hormone induces diabetes or reveals it at an early stage when it otherwise would by asymptomatic.
No studies have monitored the long-term effects of growth hormone misuse among healthy young people who have no hormone deficiency, they wrote (Br. J. Sports. Med. 2007 Feb. 26 [Epub doi:10.1136/bjsm.2006.030585])