Central serous chorioretinopathy associated with high-dose follistatin-344: a retrospective case series
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ORIGINAL PAPER
Central serous chorioretinopathy associated with high-dose follistatin-344: a retrospective case series ¨ ncu¨l . Mehmet Fuat Alakus¸ Umut Dag˘ . Mehtap C ¸ ag˘layan . Hasan O
Received: 24 January 2020 / Accepted: 30 June 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To present 11 bodybuilding athletes who developed central serous chorioretinopathy (CSCR) following high-dose subcutaneous follistatin-344, a peptide-based performance and image enhancing drug, injections to increase muscle mass. Methods This is a retrospective case series from one institution. Demographic and clinical data of 11 patients who were admitted to our clinic with decreased visual acuity after high-dose follistatin344 injections and optical coherence tomography (OCT) findings consistent with CSCR were analyzed. Results All 11 patients were male, and the mean age was 36.8 ± 8.1 years. All patients had a history of injecting complete 1 mg vials of follistatin-344 subcutaneously in the abdomen. There was a history of a single previous high-dose follistatin-344 injection in eight patients and multiple previous injections in three patients. At the time of diagnosis, ten patients had unilateral CSCR findings and one had bilateral CSCR findings. In all eight patients with a history of only one injection, subretinal fluid completely disappeared after an average of 2.3 ± 0.7 months and symptoms regressed. Recurrent CSCR developed in three
¨ ncu¨l M. F. Alakus¸ U. Dag˘ M. C¸ag˘layan (&) H. O Department of Ophthalmology, University of Health Sciences, Diyarbakir Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey e-mail: [email protected]
patients with a history of multiple follistatin-344 injections. Conclusion Follistatin-344 injection can be considered as a risk factor for CSCR. To take medical history from CSCR patients including follistatin-344 use may be important to reveal the CSCR etiology. Keywords Athletes Central serous chorioretinopathy Follistatin Performance and image enhancing drugs
Introduction Central serous chorioretinopathy (CSCR) is characterized by neurosensory serous retinal detachment, with or without pigment epithelial detachment. Dysfunction of retinal pigment epithelium (RPE), choroid, and hypothalamus–pituitary–adrenal (HPA) system was claimed in CSCR etiopathogenesis [1–3]. Actually, all three theories complete each other. However, increased circulation of corticosteroids (CS) still appears to be the most important factor [2]. Type A personality, male gender, psychological stress, pregnancy, mineralocorticoids, androgens, and some drugs are also defined as risk factors for CSCR [4–8]. These known risk factors may cause changes in hormonal status of HPA system. Also, glucocorticoid, mineralocorticoid, and androgen levels are controlled by the pituitary gland that governs the body like an orchestra
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Int Ophthalmol
conductor. So, HPA axis dysfunction may play an important role in CSCR etiopathogenesis. Follistatin-344 (A
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