Spontaneous Splenic Rupture in a Patient With Recent Use of Performance-Enhancing Compounds: A Case Report and Literature Review.
This case report describes a 54-year-old male who presented to the emergency department with acute left upper quadrant pain and vomiting, and was found to have atraumatic splenic rupture (ASR) — a rare, potentially fatal condition. The patient had recently been using two performance-enhancing compounds: MK-677 (ibutamoren), a growth hormone secretagogue, and RAD-140 (testolone), a selective androgen receptor modulator (SARM). CT imaging confirmed a large perisplenic hematoma. Initial management with splenic artery embolization provided only transient stabilization, and the patient ultimately required emergency laparotomy with total splenectomy. Histopathology revealed extensive splenic infarction and features suggestive of an underlying vascular malformation. The authors speculate — without establishing causation — that the pharmacological effects of RAD-140 and MK-677 on androgen receptor signalling and IGF-1 pathways may have contributed to splenic complications, drawing an analogy to the known association between anabolic steroids and peliosis. No prior literature directly links these compounds to splenic pathology. The report highlights the importance of prompt diagnosis and surgical management of ASR. Key limitations include the single-patient design, inability to confirm causality, and presence of a potential pre-existing vascular malformation as a confounding factor.
Why this grade: A single case report in one human patient cannot establish causation between the performance-enhancing compounds and splenic rupture, and a pre-existing vascular malformation represents a major confound.
Atraumatic splenic rupture (ASR) is a rare but life-threatening surgical emergency that most commonly occurs in pathologically abnormal spleens. We present a unique case of ASR in a middle-aged man with recent use of performance-enhancing compounds, managed with both embolization and surgery. This case highlights an unusual potential contributing risk factor and underscores the importance of prompt diagnosis and definitive management of ASR. A 54-year-old male presented to the emergency department with acute left upper quadrant abdominal pain and vomiting. Notably, he had recently been using MK-677 (ibutamoren), a growth hormone secretagogue, and RAD-140 (testolone), a selective androgen receptor modulator (SARM), for bodybuilding purposes. The patient denied any history of trauma. Computed tomography revealed a large perisplenic hematoma consistent with splenic rupture. Following initial resuscitation, emergent splenic artery embolization was performed to control hemorrhage. This intervention stabilized the patient transiently; however, he ultimately required an emergency laparotomy with total splenectomy. Histopathological examination demonstrated large areas of splenic infarction, with features raising the possibility of an underlying vascular malformation. These findings underscore the importance of recognising ASR in patients with acute abdominal pain and vascular risk factors. We explore the potential and speculative role of performance-enhancing compounds in precipitating splenic complications, drawing parallels to the established association between traditional anabolic steroids and peliosis - blood-filled vascular cavities that predispose to rupture. While RAD-140 and MK-677 have not been previously linked to splenic pathology, their pharmacological effects on androgen receptor signalling and IGF-1 pathways warrant consideration as possible contributing factors, particularly in the context of a suspected pre-existing vascular malformation. Early recognition, aggressive resuscitation, and timely surgical intervention remain critical, as delayed diagnosis carries significant mortality.
Educational summary of published research — not medical advice. License: cc by. Full text is shown only where licensing permits.