On Evaluation Of Intake Of Doping Agents In Sports - Case Study Example

Case Study On Evaluation Of Intake Of Doping Agents In Sports Case scenario 18 year old Kylie, a successful competitive cyclist is under training for 2012 London Olympics. She has often been noticed to have maintained a very impressive speeds over great distances without tiring in circumstances when other cyclists became breathless and eventually developed muscle cramps. The UK-anti-doping organization has announced conduction of doping tests on several athletes competing at the London Olympics, one of them being Kylie. The reason why Kylie is being tested is because of her high performance even in long distance cycling and at high altitudes, endurance and delayed fatigue. In this assignment, various tests to detect and confirm intake of doping agents will be discussed with reference to Kylie. Suspected diagnosis Intake of doping agents like anabolic steroids or erythropoietin Discussion A career in sports will mean lots of choices and compromises. Athletes may have to sacrifice their social and family life and spend lots of money to build their career. They may also suffer from pain related to the physical work involved in sports. But of all these, the most important aspect which an athlete needs to put up with is 'pressure to perform.' Pressure is the essence of sports, especially competitive sports wherein certain pivotal movements by the sportsmen determine who wins and who loses. And those who can rise to the occasion are great athletes. It is because of the pressure to perform that some sportsmen resort to other methods of building their strength and endurance, mainly drugs. Drugs which are used to enhance performance are anabolic androgenic steroids, stimulants like ephedra and caffeine, nonsteroidal nonstimulant performance-enhancing agents like creatine, erythropoietin, beta-hydroxy-beta methyl butyrate, human growth hormone and insulin-like growth factor (Dhar et al, 2005). Of these, the most commonly used drugs are anabolic androgenic steroids or AAS and erythropioetin. AAS are basically synthetic steroid hormones related to the hormone testosterone. They are easily available. Administration of the drugs into the body causes many anabolic physiological effects like increased synthesis of protein and increased appetite. Increased synthesis of protein leads to increase in muscle mass, muscle strength and increase in bone growth (Hartgens and Kuipers, 2004). These muscle building properties of the drugs drive the sportsmen and body builders to take the drugs. These drugs are basically manufactured for medical purposes like treatment of osteoporosis, anemias associated with renal failure, sickle cell anemia, aplastic anemia and bone marrow dysfunction; dysfunction of the gonads, stimulation of growth in short stature associated with Turner syndrome, gynecological disorders, angioedema and chronic wasting disorders like cancer and AIDS (Kickman and Gower, 2003). The commonly used anabolic steroids are oxandrolone, oxymetholone, stanozolol, nandrolone decanoate and nandrolone phenpropionate (Hartgens and Kuipers, 2004). These drugs can be administered orally, transdermally and by injection. There are various patterns of usage of anabolic steroids. The common techniques used as a part of anabolic steroid cycles are cycling, stacking and pyramiding. In cycling, multiple doses of the drug is given over a period of time and then stopped for sometime only to resume later. This routine is continued. In stacking, 2 or more drugs are given cyclically. In pyramiding, the drug is started at the lowest dose possible and then escalated with time either by increasing the number and frequency of a single drug or with multiple drugs and after the pinnacle is reached, the dosage is then gradually reduced to zero. Pyramiding typically occurs over 6 to 12 weeks (NIDA, 2008). Once administered into the body, anabolic steroids travel into the muscle tissue and reach the androgen receptors which deliver the hormone molecules into the cell. After entering the muscle cells, the steroids interact with the DNA and trigger the synthesis of protein which further promotes cell growth (Graham et al, 2008). Depending upon the amount and type of hormones introduced, the physique of the person either becomes bulky or toned. The steroids also help overcome the sores which occur in overused muscles. Sore muscles result from increased production of cortisol during intense exercise. Cortisol causes breakdown of muscle tissues resulting in sores. Androgenic steroids prevent sores by blocking cortisol from binding to its receptor sites in the muscle cell (Dhar et al, 2005). Stimulants like ephedra have several alkaloids which act on cardiac factors like blood pressure directly or indirectly. They are ergogenic and have an impact on weight loss and performance enhancement. Caffeine is a central nervous system stimulant and reduces perception of fatigue. It had potent adrenergic effects also. It also has various other effects like stimulation of the release of acetylcholine at muscle level, stimulation of muscle cell and induction of lipolysis. Alone, or when taken with ephedra, it prolongs endurance to fatigue (Dhar et al, 2005). Creatine consists of glycine, arginine and methionine. It is an amine and causes increase in sustenance of maximal energy during activities which are anerobic, thus delaying fatigue of muscles. Creatine acts as a substrate for hydrogen ions during the process of regeneration of adenosine triphosphate from adenosine diphosphate. Erythropoietin induces erythrocytosis, thus increasing the oxygen carrying capacity of the blood (Borroso et al, 2008). This in turn improves skeletal muscle performance without increasing cardiac output. β-hydroxy-β-methylbutyrate, a metabolite of leucine decreases catabolism and causes reduction in total body fat. At the same time, it increases the lean body mass and, strength and performance of the muscles. Human growth hormone and insulin-like growth factor increase fat-free mass and strength of the muscles. They also cause decrease in recovery time (Dhar et al, 2005). Screening tests The main screening tests which Kylie was subjected to was packed cell volume and red blood cell count to detect erythrocytosis, urine gas-chromatography-mass spectrometry for anabolic steroids, urine assays for immunological recognition of endogenous peptide hormones like erythropoietin and insulin-like growth factors, anti-insulin antibodies through radioimmunoassay for detection of synthetic insulin in blood and urine tests for creatine excretion study. Gas-chromatography-mass spectrometry is the most commonly employed screening test for detection of AAS abuse (Refer Appendix). Other tests useful for detection of AAS are liquid chromatography-mass spectrometry and carbon isotope mass spectrometry (Graham et al, 2008). This test proved positive for Kylie for nandrolone. The test detected 6ng/mL of the steroid (normal being less than 1 ng/ml). Other tests were negative. Evaluation of the results Detailed examination of Kylie revealed that she had baldness and features of masculinization like growth of hair on chin and chest and hoarsness of voice. Kylie managed to cover these changes by waxing her hair and telling everyone that she has a vocal cord cyst because of which she has hoarse voice. She also had irregular menstruation and enlargement of clitoris. Serum cholesterol levels revealed hypertriglyceridemia. Her friends expressed that they found subtle changes in her behaviour over the past couple of years in terms of irritability and paranoia. It can be said that all these changes in Kylie are due to long term abuse of nanadrolone. Anabolic steroids have many known side effects. The immediate side effects may be subtle and go unrecognised. Detrimental effects of the steroids are caused by improper usage of the drugs due to inadequate knowledge and ignorance. The side effects can be quite serious and irreversible (Calfee and Fadale, 2006). Long term intake of anabolic steroids can result in increase in low-density lipoproteins or bad cholesterol, thus increasing the risk of cardiovascular ailment. These drugs cause increase in the production of dihydrotestosterone which accelerates baldness and also increases the risk of prostate cancer. The drugs also increase the risk of liver tumors and hepatic cysts, both of which are dangerous enough to rupture and cause internal bleeding. In men, shrinking of testicles can occur. Other adverse effects in men include decreased sperm count, infertility and gynecomastia. In women, features of masculinization can occur. Long term administration of anabolic steroids in women can cause growth of facial hair, male-pattern baldness, changes in the menstrual cycle, deepened voice resembling that of men and enlargement of clitoris. Anabolic steroids have effects in brain too. They bind to androgen and estrogen receptors in the brain and shuttle into the cell nucleus to influence patterns of gene expression (Kicman and Gower, 2003). Unlike other illicit drugs, these drugs do not cause any euphorigenic side effects. But in the long term, some impact can be seen in the brain pathways and chemicals. Thus, anabolic steroids can contribute to psychiatric dysfunction which can manifest as extreme irritability, delusions, paranoid jealousy, impaired judgement and delusions (Kicman and Gower, 2003). Another major adverse effect of anabolic steroids is addictive tendency. Those who abuse these drugs spend lots of money and time to procure these drugs. Withdrawal symptoms can occur once these drugs have been stopped. Withdrawal symptoms include fatigue, mood swings, restlessness, reduced sexual drive, steroid cravings and insomnia. The most dangerous withdrawal symptom is depression and can lead to suicide attempts (NIDA, 2008). Research has shown that some users of anabolic steroids might resort to abuse of other drugs too. The sad part about androgenic steroid abuse is there is not much research on how to treat the abuse. Supportive therapy with education can help in many cases. Rarely, the abusers may need hospitalization (NIDA, 2008). Final diagnosis: Long term abuse of nandrolone to enhance performance in cycling. Conclusion Pressure to perform made Kylie resort to abuse of nandrolone which was revealed through mass spectrography of urine sample. Her complications were indicative of the fact that she was taking these drugs for a long term. Her success in the past in terms of endurance, decreased fatiguibility and ability to perform in high altitudes and long distances was because of doping with anabolic steroid. References Barroso, O., Mazzoni, I., and Rabin, O. (2008). Hormone abuse in sports: the antidoping perspective. Asian Journal of Andrology, 10, 391–402 Calfee, R., and Fadale, P. (2006). Popular ergogenic drugs and supplements in young athletes. Pediatrics, 117 (3), e577–89. Dhar, R., Stout, W., Link, M.S., Homoud, M.K., Weinstock, J., and Estes, N.A.M. (2005). Cardiovascular Toxicities of Performance-Enhancing Substances in Sports. Mayo Clin Proc, 80(10), 1307- 1315 Fannin, S.T., Ofsa, B., Wells, B.R., and Sample, R.H.B. (2006). Analysis of Anabolic Steroids in Urine by GC-MS/MS with ans External Source Ion Trap Mass Spectrometer. Retrieved on 5th May, 2010 from http://www.thermo.com/eThermo/CMA/PDFs/Articles/articlesFile_1000001009424.pdf Graham, M.R., Davies, B., Grace, F.M., Kicman, A., Baker, J.S. (2008). Anabolic steroid use: patterns of use and detection of doping. Sports Med., 38(6), 505-25 Hartgens, F., and Kuipers, H. (2004). Effects of androgenic-anabolic steroids in athletes. Sports Med., 34 (8), 513–54. Kicman, A.T., and Gower, D.B. (2003). Anabolic steroids in sport: biochemical, clinical and analytical perspectives. Annals of Clinical Biochemistry, 40, (Pt 4), 321–56. NIDA. (2008). NIDA InfoFacts: Steroids (Anabolic-Androgenic). Retrieved on 5th May, 2010 from http://www.nida.nih.gov/Infofacts/steroids.html Appendix (Source: Fannin et al, 2006) (Source: Fannin et al, 2006) (Source: Fannin et al, 2006) Read More