Do steroids increase liver function tests (LFTs)?

From the Guidelines

Steroids can increase liver function tests (LFTs), but the effect is generally reversible and dose-dependent. Both oral anabolic steroids and corticosteroids can elevate liver enzymes, particularly AST, ALT, and alkaline phosphatase 1. The risk of hepatotoxicity is higher with anabolic steroids, especially C-17 alpha-alkylated forms, and increases with higher doses and longer duration of use 1.

Key Points to Consider

• The elevation in LFTs typically occurs within weeks of starting therapy and may persist throughout treatment 1.
• Patients on steroid therapy should have regular liver function monitoring, especially during the first few months of treatment, and should be advised to avoid alcohol and other hepatotoxic substances while taking these medications 1.
• LFT abnormalities are usually reversible after discontinuation of steroids, though recovery may take weeks to months 1.
• The management of steroid-induced liver injury involves close monitoring, temporary discontinuation of the offending agent, and consideration of alternative treatments or dose adjustments 1.

Clinical Recommendations

• Monitor patients on steroid therapy for signs and symptoms of liver injury and hepatic biochemical tests, including serum ALT, AST, ALP, TBL, and DBL 1.
• Consider hepatology consult for patients with grade 2 or higher liver toxicity 1.
• Temporarily hold or discontinue steroids in patients with significant liver toxicity, and consider alternative treatments or dose adjustments 1.

Conclusion Not Applicable - Outcome Based on Morbidity, Mortality, and Quality of Life

The use of steroids should be carefully weighed against the potential risks and benefits, particularly in patients with pre-existing liver disease or those taking other hepatotoxic medications 1. Regular monitoring and prompt management of liver toxicity can help minimize the risks associated with steroid therapy and improve patient outcomes.

From the Research

Steroids and Liver Function Tests (LFTs)

• The relationship between steroids and liver function tests (LFTs) is complex and has been studied in various contexts.
• A study from 1999 2 found that anabolic steroid use may not be as strongly associated with hepatotoxicity as previously thought, as elevated liver enzymes (AST and ALT) in bodybuilders using steroids may be due to muscle damage rather than liver damage.
• However, another study from 2022 3 noted that steroids may have a potential harmful effect in patients with acute liver injury, highlighting the need for careful consideration of their use in such cases.
• A study from 1976 4 found that treatment failure with standard regimens containing steroids was more common in patients with chronic active liver disease who had more severe liver disease, as judged by liver function tests.

Anabolic Steroids and LFTs

• Anabolic steroids, particularly 17 alpha-alkylated steroids, can cause hepatic alterations, ranging from abnormal liver function tests to life-threatening liver tumors 5.
• A study from 1999 2 found that bodybuilders using anabolic steroids had elevated AST and ALT levels, but normal GGT levels, suggesting that the elevated liver enzymes may be due to muscle damage rather than liver damage.

Corticosteroids and LFTs

• Corticosteroids are used to treat severe alcohol-associated hepatitis, and a study from 2021 6 found that they improved 30-day survival in patients with MELD scores between 21 and 51.
• However, the study also found that corticosteroids did not improve survival in patients with MELD scores above 51, suggesting that their use may not be beneficial in patients with very severe liver disease.

Conclusion is not allowed, so the response will continue with more information

• It is essential to consider the specific context and type of steroid being used when evaluating the relationship between steroids and LFTs.
• Healthcare professionals should carefully monitor liver function tests and other markers of liver health when prescribing steroids, particularly in patients with pre-existing liver disease or those who are at risk of developing liver damage 3, 5.