💊 Chapter 733 · Performance-Enhancing Aids

Nelson Textbook of Pediatrics 22nd Edition | Anabolic-androgenic steroids (AAS): increase muscle mass, strength. Side effects: testicular atrophy, gynecomastia, hepatotoxicity, cardiovascular risk, aggression, acne, striae. Cycling, stacking, pyramiding use patterns. Creatine: increases strength/power, may cause heat cramps, dehydration. Stimulants (amphetamines, caffeine): increase alertness, risk of arrhythmias, heat stroke. Human growth hormone (hGH): limited evidence, side effects (acromegaly, cardiomyopathy). Erythropoietin (EPO)/blood doping: increases endurance, risk of thrombosis, stroke. Screening and counseling at preparticipation exam.

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📋 30 Clinical Scenarios — Performance-Enhancing Aids

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Performance-Enhancing Aids

Select a presentation to review diagnostic clues and management per Nelson Ch 733.

📋 Stepwise Management (Counseling & Screening)

🔑 Key Principles — Nelson Chapter 733
• Anabolic-androgenic steroids (AAS): Cycling (on/off periods), stacking (multiple agents), pyramiding (tapering). Side effects: testicular atrophy, gynecomastia, acne, striae, aggression ('roid rage'), hepatotoxicity (peliosis hepatitis, tumors), cardiovascular (decreased HDL, hypertension, LVH).
• Creatine: Increases strength/power in short-duration, high-intensity exercise. Side effects: dehydration, heat cramps, weight gain. No long-term safety data in adolescents.
• Stimulants (amphetamines, caffeine): Increase alertness, reduce fatigue. Risks: arrhythmias, heat stroke, seizures, addiction.
• Human growth hormone (hGH): Limited evidence for performance enhancement. Side effects: acromegaly, cardiomyopathy, carpal tunnel, hyperlipidemia, insulin resistance.
• Erythropoietin (EPO)/blood doping: Increases oxygen-carrying capacity. Risks: thrombosis (stroke, MI, pulmonary embolism), immune reaction.
• Counseling: Screen at preparticipation exam. Address healthy nutrition, training, and risks of supplements.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Performance-Enhancing Aids (Nelson 733)