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[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance."
(Wilmore and Costill) 
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0 6 - 0 9 - 2 0 0 5 Growth hormone abuse and bodybuilding as aetiological factors in the development of bilateral internal laryngocoeles. A case report.
Moor JW, Khan MI. Laryngocoele is defined as an abnormal dilatation of herniation of the laryngeal saccule and was first described by Larrey, surgeon to Napoleon's army, in Egypt in 1829. He described compressible pouches related to the thyrohyoid membrane in the Muezzin who called the faithful to prayer from the minaret.
The hypothesis that patients found to have laryngocoeles often engage in hobbies requiring considerable increases in intrathoracic pressure has been described as 'intuitively attractive but improbable', although Amin and Maran suggest that there are a variety of factors that may bring an asymptomatic large saccule to the patient's attention as a symptomatic laryngocoele. These include blowing, straining and coughing. The laryngeal ventricle is an opening between the true and false cords within the supraglottis and is lined by pseudostratified ciliated epithelium that is rich in submucosal mucous and minor salivary glands. The saccule is the appendix of the ventricle, which proceeds upward between the thyroid cartilage and the ventricular fold and has a volume of 0.5 mls. In their review of laryngocoeles, Stell and Maran suggest that the ventricle and saccule of the larynx are 'an atavistic remnant corresponding to the lateral laryngeal air sacs of the higher anthropoid apes'. Such air sacs are also found in frogs, toads and in the garnet fish. We report the first known case where the combination of the abuse of anabolic steroids, growth hormone (GH) and regular weight training exercise to increase muscle bulk may be implicated in the development of bilateral internal laryngocoeles. Case report A 36-year-old man presented acutely with increasing hoarseness and difficulty breathing, especially during sleep, causing him to wake up three or four times through the night. He was a professional bodybuilder and admitted that 2 months earlier he had abused growth hormone as an aid to increasing muscle bulk; this had caused him some minor breathing difficulties so he had discontinued it at that time. In the week prior to his presentation, he had once again abused growth hormone. He was also abusing anabolic steroids at that time and had regularly done so in the past. Examination revealed that he had stridor, but no other significant respiratory distress; flexible nasopharyngolaryngoscopy showed a supraglottic swelling on the right side of his larynx causing restricted vocal cord movements and generally dehydrated laryngeal. This patient was a very serious and successful professional bodybuilder. He had been involved in bodybuilding for 18 years and had won various National and European titles. In the run-up to a competition, when he presented to our department, his training schedule involved 2 h per day of cardiovascular exercise and on 4 days per week would specifically lift weights to increase muscle bulk. At that time he was able to 'bench press' - where the athlete lies on their back and pushes a bar connected to the weights vertically up and then lowers it again—a weight of approximately 200 kgs (450 lbs). Lifting of such large weights is technically difficult and requires precise control of breathing. For the previous 10 years, he had used anabolic steroids to boost his performance; his steroid regime was to inject 50–100 mg of testosterone-based steroid 2–3 times per week for a month; the following month he took none as recommended to him by the product suppliers. In his opinion, this was quite a modest dose in comparison to other competitors who despite taking larger doses did not manage to achieve his successes. He had in the past taken various doses and preparations of anabolic steroids; he had settled on two particular preparations, Virormone and Winstrol, which he found gave him the most muscle bulk without intolerable side effects. His use of growth hormone was infrequent. Several years previously he had tried growth hormone, injecting 3–4 IUs on alternate days, but developed problems with dysphonia (= moeilijk kunnen praten – red.) and so had stopped taking it. He was however moderately impressed with the results in terms of increased muscle bulk and reduction of body fat and so used growth hormone again in preparation for a competition prior to his presentation to our department. He used a higher dose than he had previously, taking 6 IUs on alternate days for 3 weeks. As mentioned above this had caused some difficulty with his breathing and so he discontinued taking it for 2 months. He then took the same dose over 1 week immediately before being admitted acutely. Growth hormone, anabolic steroid abuse and bodybuilding in combination have never previously been implicated in the aetiology of laryngocoele. In this patient it is likely that the antinatriuretic effect of exogenous growth hormone caused oedema of mucosa of the neck of the saccule where mucus glands and minor submucosal salivary glands are abundant. Combined with the patient's professional activities of weight lifting, which obviously causes large increases in intratracheal pressure, he developed his laryngocoeles. There are no other reports in the medical literature of the antinatriuretic effects of growth hormone causing mucosal oedema sufficient to cause laryngocoeles or obstruction of any other mucosal lined tracts. Following the development of the problems discussed here, he continues to perform as a professional bodybuilder and has discontinued his use of both anabolic steroids and growth hormone. His weight has reduced by approximately 6 kg and he admits his overall size and muscle bulk has reduced. He is, as are his competitors, pleasantly surprised with the results he has been able to achieve without the use of anabolic steroids and growth hormone. |
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