Forensic Post-Mortem Investigation in AAS Abusers: Investigative Diagnostic Protocol. A Systematic Review

Forensic Post-Mortem Investigation in AAS Abusers : Investigative Diagnostic Protocol. A Systematic Review / Massimiliano Esposito, Gabriele Licciardello, Federico Privitera, Salvatore Iannuzzi, Aldo Liberto, Francesco Sessa, Monica Salerno. - (Diagnostics 11 (2021) 8 (21 July); 1307)

  • PMID: 34441242
  • PMCID: PMC8393338
  • DOI: 10.3390/diagnostics11081307


Anabolic-androgenic steroids (AASs) are a group of synthetic molecules derived from testosterone and its precursors. AASs are widely used illicitly by adolescents and athletes, especially by bodybuilders; AASs are among the most used drugs for improving physical performance, as well as for aesthetic purposes. The use of AASs by professional and recreational athletes is increasing worldwide. This review focused on deaths related to AAS abuse and to investigation of the autopsy results and histopathological findings using a rigorous methodology protocol covering: a complete autopsy, histological analysis, and a broad toxicological investigation. Moreover, we aimed to define an investigative diagnostic protocol supporting forensic pathologists during the post-mortem investigation of AAS abusers. This review was conducted using PubMed Central and Google Scholar databases to find articles published between 1 January 1968 and 30 June 2021, using the following key terms: "(anabolic-androgenic steroids) AND (autopsy); (anabolic-androgenic steroids) AND (forensic)". A total of 939 articles were screened and 926 did not meet the inclusion criteria. In conclusion, 14 articles were included in this systematic review, reporting 137 fatal cases of AAS abuse in total. The histopathologic studies showed myocardial damage characterized by myocyte hypertrophy, focal myocyte damage with myofibrillar loss, interstitial fibrosis, mostly subepicardial, and small vessel disease. Indeed, in AAS-related cases, autopsy plays a pivotal role in the study of AAS adverse effects and organ damage related to their use or abuse. This systematic review aimed to define a specific workflow in death cases related to AASs, suggesting important future insights to better clarify sudden deaths related to AASs, such as the use of miRNAs. The forensic community needs a unified approach in cases of suspected death related to the use of AASs. There are several occasions to apply this workflow, for example in cases of death of bodybuilders and of young people who die in gymnasiums or during sports activities.

Original document


21 July 2021
Esposito, Massimiliano
Iannuzzi, Salvatore
Liberto, Adlo
Licciardello, Gabriele
Privitera, Federico
Salerno, Monica
Sessa, Francesco
Other organisations
Università degli Studi di Catania - University of Catania
Università degli Studi di Foggia - University of Foggia
Doping classes
S1. Anabolic Agents
Medical terms
Athlete deceased
Health effects
Document category
Scientific article
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Pdf file
Date generated
18 October 2021
Date of last modification
26 October 2021
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