Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal γ-Glutamyl-Transpeptidase

The indisputable hepatotoxicity of anabolic androgen steroids has already been well substantiated in the literature, eventhough the exact pathophysiologic mechanisms are still being elucidated. Androgen-induced liver injury presents primarily with acute intrahepatic cholestasis accompanied by markedly elevated cholestatic enzymes and diverse levels of aminotransferases. A case report of a young male with remarkable jaundice due to acute anabolic androgeninduced cholestasis is presented. Interestingly, γ-glutamyl transpeptidase remained normal throughout the patient’s diagnostic workup. Histopathology was indicative of pure, “bland” intrahepatic cholestasis with minimal inflammation but significant fibrosis. The patient was successfully treated with ursodeoxycholic acid and glucocorticosteroids. The significance of normal γ-glutamyl transpeptidase along with the histopathological findings and the possible pathophysiological mechanisms are finally discussed.