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Selective Androgen Receptor Modulators: An Emerging Liver Toxin.

Haseeb Mohideen1, Hafsa Hussain2, Dushyant Singh Dahiya3

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Summary

Selective androgen receptor modulators (SARMs) can cause liver injury. This review details SARM-induced liver injury (DILI), a cholestatic syndrome, and highlights the need for further research on diagnosis and management.

Keywords:
Anabolic steroidsAndrogen receptor agonistCholestasisDrug-induced liver injury

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Area of Science:

  • Pharmacology
  • Hepatology
  • Toxicology

Background:

  • Selective androgen receptor modulators (SARMs) are nonsteroidal drugs offering tissue-selectivity over anabolic androgenic steroids (AASs).
  • SARMs are explored for therapeutic uses but are also misused as performance-enhancing drugs.
  • Emerging cases link SARMs to drug-induced liver injury (DILI), necessitating a review of their hepatotoxicity.

Purpose of the Study:

  • To review current knowledge on drug-induced liver injury (DILI) associated with Selective Androgen Receptor Modulators (SARMs).
  • To evaluate reported cases and information regarding SARMs and liver injury.
  • To understand the characteristics and potential complications of SARM-related hepatotoxicity.

Main Methods:

  • Literature search on SARMs and liver injury.
  • Evaluation of relevant case reports and scientific information.
  • Analysis of the clinical presentation and pathology of SARM-induced liver injury.

Main Results:

  • SARMs are linked to a cholestatic syndrome, similar to DILI from AASs.
  • This syndrome presents as bland cholestasis with minimal inflammation or necrosis.
  • Patients exhibit jaundice, marked hyperbilirubinemia, and mild elevations in liver enzymes.

Conclusions:

  • Cessation of the SARM typically leads to patient improvement.
  • No definitive treatment for SARM-related DILI is established.
  • Further research is crucial for understanding the diagnosis, management, and complications of SARM-induced liver injury.