0
December 8, 1989, Vol 262, No. 22 >
ARTICLE | December 8, 1989

Hooked on Hormones?: Title and subTitle BreakAn Anabolic Steroid Addiction Hypothesis FREE

Kenneth B. Kashkin, MD; Herbert D. Kleber, MD
[+] Author Affiliations

Reprint requests to the Department of Psychiatry, Yale University School of Medicine, 34 Park St, New Haven, CT 06519 (Dr Kashkin).


JAMA. 1989;262(22):3166-3170. doi:10.1001/jama.1989.03430220089036
Text Size: A A A
Published online
Article
References

Widespread illicit anabolic steroid use has recently been reported. A review of available evidence suggests that elevations of serum levels of steroid hormones, including anabolic steroids, have profound psychological effects. Long-term, high-dose anabolic steroid use may lead to a preoccupation with drug use, difficulty stopping despite psychological side effects, and drug craving. Reductions in serum levels of steroid hormones appear to result in acute hyperadrenergic withdrawal symptoms that respond to steroid replacement or to agents that also ameliorate withdrawal symptoms in alcohol and opioid dependence. A delayed depression syndrome when serum steroid levels drop precipitously has been reported that appears similar to that observed in withdrawing cocainedependent individuals. We conclude that a proportion of anabolic steroid abusers may develop a previously unrecognized sex steroid hormone—dependence disorder and that treatment should be based on research into steroid effects on opioid and aminergic neurotransmission systems and relapse prevention.

(JAMA. 1989;262:3166-3170)

REFERENCES

1 +
Taylor WN, Black AB.  Pervasive anabolic steroid use among health club athletes . Ann Sports Med. 1987;;3:155-159.
2 +
Buckley WE, Yesalis CE III, Friedl KE, Anderson WA, Streit AL, Wright JE.  Estimated prevalence of anabolic steroid use among male high school seniors . JAMA. 1988;;260:3441-3445.
3 +
Burkett LN, Falduto MT.  Steroid use by athletes in a metropolitan area . Phys Sports Med. 1984;;12( (8) ):69-74.
4 +
Moore WV.  Anabolic steroid use in adolescence . JAMA. 1988;;260:3484-3486.
5 +
Schnoll SH, Karrigen J, Kitchen SB, Daghestani A, Hansen T.  Characteristics of cocaine abusers presenting for treatment . Natl Inst Drug Abuse Res Monogr Ser. 1985;;61:171-181.
6 +
American Psychiatric Association Advisory Committees on Diagnostic Categories. Diagnostic and Statistical Manual of Mental Disorders . 3rd ed, revised. Washington, DC: American Psychiatric Association; 1987;.
7 +
Tennant F, Black DL, Voy RO.  Anabolic steroid dependence with opioid-type features . N Engl J Med. 1988;;319:578.
8 +
Brower KF, Blow FL, Beresford TP, Fuelling C.  Anabolic-androgenic steroid dependence . J Clin Psychiatry. 1989;;50:31-33.
9 +
Haupt HA, Rovere GD.  Anabolic steroids: a review of the literature . Am J Sports Med. 1984;;12:469-484.
10 +
Wilson JD.  Androgen abuse by athletes . Endocr Rev. 1988;;9:181-199.
11 +
Lamb DR.  Anabolic steroids in athletics: how well do they work and how dangerous are they ? Am J Sports Med. 1984;;12:31-38.
12 +
Sklarek HM, Mantovani RP, Erens E, Heisler D, Niederman MS, Fein AM.  AIDS in a body-builder using anabolic steroids . N Engl J Med. 1984;;311:861-862.
13 +
Frankle MA, Cicero GJ, Payne J.  Use of androgenic anabolic steroids by athletes . JAMA. 1984;;252:482.
14 +
Alen M, Raahkila P, Reinila M, Vihko R.  Androgenic-anabolic steroid effects on serum thyroid, pituitary, and steroid hormones in athletes . Am J Sports Med. 1987;;15:357-361.
15 +
Santen RJ.  The testis . In: Felig P, Baxter JD, Broadus AE, Frohman LA, eds. Endocrinology and Metabolismn . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:821-905.
16 +
Martini L.  The 5 alpha-reduction of testosterone in the neuroendocrine structures: biochemical and physiological implications . Endocr Rev. 1982;;3:1-25.
17 +
Alen M, Reinila M, Vihko R.  Response of serum hormones to androgen administration in power athletes . Med Sci Sports Exerc. 1985;;17:354-359.
18 +
Martin JB, Reichlin S. Clinical Neuroendocrinology. 2nd ed. Philadelphia, Pa: FA Davis Co Publishers; 1987;.
19 +
Mayer M, Rosen F.  Interaction of glucocorticoids and androgens with skeletal muscle . Metabolism . 1977;;29:937-962.
20 +
Rance NE, Max SR.  Modulation of the cytosolic androgen receptor in striated muscle by sex steroids . Endocrinology. 1984;;115:862-866.
21 +
Reban RW, Yen SSC.  Endocrine rhythyms in gonadotropins and ovarian steroids with reference to reproductive processes . In: Krieger DT, ed. Reproductive Rhythyms . New York, NY: Raven Press; 1979;:259-298.
22 +
Miller NE, Hubert G, Hamilton JB.  Mental and behavioral changes following male hormone treatment of adult castration, hypogonadism and psychic impotence . Proc Soc Exp Biol Med. 1938;; 38:538-540.
23 +
Salmon UJ, Geist SH.  Effect of androgens upon libido in women . J Clin Endocrinol. 1943;; 3:235-238.
24 +
Altschule MD, Tillotson KJ.  The use of testosterone in the treatment of depressions . N Engl J Med. 1948;;239:1036-1038.
25 +
Woodbury DM.  Relation between the adrenal cortex and the central nervous system . Pharmacol Rev. 1958;;10:275-357.
26 +
Tyrrell JB, Baxter JD.  Glucocorticoid therapy . In: Felig P, Baxter JD, Broadus AB, Frohman LA, eds. Endocrinology and Metabolism. 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:788-817.
27 +
Freed DLJ, Banks AJ, Longson D, Burley DM.  Anabolic steroids in athletes: crossover double-blind trial on weight lifters . Br Med J. 1975;; 2:471-473.
28 +
Hervey GR.  Are athletes wrong about anabolic steroids ? Br J Sports Med. 1975;;9:74-77.
29 +
Lucking MT.  Steroid hormones in sports: special reference: sex hormones and their derivatives . Int J Sports Med. 1982;;3:65-67.
30 +
Taylor WN.  Are anabolic steroids for the long distance runner ? Ann Sports Med. 1984;;2:51-52.
31 +
Strauss RH, Wright JE, Finermin GA, Catlin DH.  Side effects of anabolic steroids in weight trained men . Phys Sports Med. 1983;;11( (12) ):87-96.
32 +
Strauss RH, Liggett MT, Lanese RR.  Anabolic steroid use and perceived effects in ten weight-trained women athletes . JAMA. 1985;;253:2871-2973.
33 +
Vest SA, Howard JE.  Clinical experiments with the use of male sex hormones . J Urol. 1938;;40;154-183.
34 +
Mirin SM, Weiss RD.  Affective illness in substance abusers . Psychiatr Clin North Am. 1986;;9:503-514.
35 +
Gawin FH, Ellinwood EH.  Cocaine and other stimulants: actions, abuse, and treatment . N Engl J Med. 1988;;318:1173-1182.
36 +
Pope HG, Katz DL.  Affective and psychotic symptoms associated with anabolic steroid use . Am J Psychiatry. 1988;;145:487-490.
37 +
Freinher JP, Alvarez W.  Androgen-induced hypomania . J Clin Psychiatry. 1985;;46:354-355.
38 +
Pope HG Jr, Katz DL.  Body builders psychosis . Lancet. 1987;;1:863.
39 +
Annitto J, Layman WA.  Anabolic steroids in acute schizophrenic episodes . J Clin Psychiatry. 1980;;41:143-144.
40 +
Kleber HD.  Epidemic cocaine abuse: America's present, Britain's future ? Br J Addict. 1988;; 83:1359-1371.
41 +
Gold MS, Redmond DE Jr, Kleber HD.  Noradrenergic hyperactivity in opiate withdrawal supported by clonidine reversal of opiate withdrawal . Am J Psychiatry. 1979;;136:100-102.
42 +
Linnoila M, Mefford I, Nutt D, Adinoff B.  Alcohol withdrawal and noradrenergic function . Ann Intern Med. 1987;;107:875-889.
43 +
Sherwin BB, Gelfand MM.  Differential symptom response to parenteral estrogen and/or androgen administration in the surgical menopause . Am J Obstet Gynecol. 1985;;151:153-160.
44 +
McLachlan RI, Healy DL, Burger HG.  The ovary: basic principles and concepts, B: clinical . In: Felig P, Baxter JD, Broadus AE, Frohman LA, eds. Endocrinology and Metabolism. 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:951-983.
45 +
Giannini AJ, Sullivan B, Sarachene J, Loiselle RH.  Clonidine in the treatment of premenstrual syndrome: a subgroup study . J Clin Psychiatry. 1988;;49:62-63.
46 +
Hamilton JA, Parry BL, Blumenthal SJ.  The menstrual cycle in context, I: affective syndromes associated with reproductive hormonal changes . J Clin Psychiatry. 1988;;49:474-480.
47 +
Hammarback S, Danber J, Backstrom T.  Relationships between symptom severity and hormone changes in women with pre-menstrual syndrome . J Clin Endocrinol Metab. 1989;;68:125-130.
48 +
Amatruda TT, Hurst MM, D'Esopo ND.  Certain endocrine and metabolic facets of the steroid withdrawal syndrome . J Clin Endocrinol Metab. 1965;;25:1207-1217.
49 +
Dixon RB, Christy NP.  On the various forms of corticosteroid withdrawal syndrome . Am J Med. 1980;;68:224-230.
50 +
Baxter JD, Tyrell JB.  The adrenal cortex . In: Felig P, Baxter JD, Broadus AE, Frohman LA, eds. Endocrinology and Metabolism. 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:511-650.
51 +
Facchinetti F, Martignoni E, Petraglia F, Sances MG, Nappi G, Genazzani AR.  Premenstrual fall of plasma beta-endorphin in patients with premenstrual syndrome . Fertil Steril. 1987;;47:570-573.
52 +
Ellingboe J, Veldhuis JD, Mendelson JH, Kuehle JL, Mello NK.  Effect of endogenous opioid blockage on the amplitude and frequency of LH secretion in normal men . J Clin Endocrinol Metab. 1982;;54:854-874.
53 +
Balzamo S, Migliari L, Sica V, et al.  The effect of androgen blockade on gonadotrophin release and LH response to naloxone . Clin Endocrinol Metab. 1987;;27:491-499.
54 +
Gawin FH, Kleber HD.  Abstinence symptomatology and psychiatric diagnosis in cocaine abusers . Arch Gen Psychiatry. 1986;;43:107-113.
55 +
Gawin FH, Kleber HD, Byck R, et al.  Desipramine facilitation of initial cocaine abstinence . Arch Gen Psychiatry. 1989;;46:117-121.
56 +
Buesching DP, Glasser ML, Frate DA.  Progression of depression in the prenatal and postpartum periods . Women Health. 1986;;11:61-78.
57 +
Kane FJ.  Postpartum disorders . In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. 4th ed. Baltimore, Md: Williams & Wilkins; 1985;:1238-1242.
58 +
Muse KN, Cetet NS, Futterman LA, Yen SC.  The premenstrual syndrome: effects of 'medical ovariectomy.' N Engl J Med. 1984;;311:1345-1349.
59 +
Catt KJ.  Molecular mechanisms of hormone action: control of target cell function by peptide, steroid, and thyroid hormones . In: Felig P, Baxter JD, Broadus AE, Frohman LA, eds. Endocrinology and Metabolism . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:82-164.
60 +
Lave L, Kenigsberg D, Pescovitz OH, et al.  The treatment of familial precocious puberty with spironolactone and testolactone . N Engl J Med. 1989;;320:496-502.
61 +
Kleber HD, Kosten TB.  Naltrexone induction: psychologic and pharmacologic strategies . J Clin Psychiatry. 1984;;45:29-38.
62 +
Lukas SE, Mendelson JH.  Electroencephalographic activity and plasma ACTH during ethanolinduced euphoria . Biol Psychiatry. 1988;;23:141-148.
63 +
Rivier C, Bruhn T, Vale W.  Effect of ethanol on the hypothalamic-pituitary-adrenal axis in the rat: role of corticotropin-releasing factor (CRF) . J Pharmacol Exp Ther. 1984;;229:127-131.
64 +
Nikolarakis KE, Almeida OFX, Sirinathsinghji DJS, Herz A.  Concomitant changes in the in vitro and in vivo release of opioid peptides and luteinizing hormone-releasing hormone from the hypothalamus following blockade of receptors for corticotropin-releasing factor . Neuroendocrinology. 1988;;47:545-550.
65 +
Gold PW, Goodwin FK, Chrousos GP.  Clinical and biochemical manifestations of depression: relation to the neurobiology of stress . N Engl J Med. 1988;;319:413-420.
66 +
Kendall DA, Stancel GM, Enna SJ.  Imipramine: Effects of ovarian steroids on modifications in serotonin receptor binding . Science. 1981;;211:1183-1185.
67 +
Kendall DA, Stancel GM, Enna SJ.  The influence of sex hormones on antidepressant-induced alterations in neurotransmitter receptor binding . J Neurosci. 1982;;2:354-360.
68 +
Heninger GR, Charney DS.  Mechanism of action of antidepressant treatments: implications for the etiology and treatment of depressive disorders . In: Meltzer HY, ed. Psychopharmacology: The Third Generation of Progress . New York, NY: Raven Press; 1987;:535-544.
69 +
Kleber HD, Topazian M, Gaspari J, Riordan CE, Kosten T.  Clonidine and naltrexone in the outpatient treatment of heroin withdrawal . Am J Drug Alcohol Abuse. 1987;;13:1-17.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Taylor WN, Black AB.  Pervasive anabolic steroid use among health club athletes . Ann Sports Med. 1987;;3:155-159.
2 +
Buckley WE, Yesalis CE III, Friedl KE, Anderson WA, Streit AL, Wright JE.  Estimated prevalence of anabolic steroid use among male high school seniors . JAMA. 1988;;260:3441-3445.
3 +
Burkett LN, Falduto MT.  Steroid use by athletes in a metropolitan area . Phys Sports Med. 1984;;12( (8) ):69-74.
4 +
Moore WV.  Anabolic steroid use in adolescence . JAMA. 1988;;260:3484-3486.
5 +
Schnoll SH, Karrigen J, Kitchen SB, Daghestani A, Hansen T.  Characteristics of cocaine abusers presenting for treatment . Natl Inst Drug Abuse Res Monogr Ser. 1985;;61:171-181.
6 +
American Psychiatric Association Advisory Committees on Diagnostic Categories. Diagnostic and Statistical Manual of Mental Disorders . 3rd ed, revised. Washington, DC: American Psychiatric Association; 1987;.
7 +
Tennant F, Black DL, Voy RO.  Anabolic steroid dependence with opioid-type features . N Engl J Med. 1988;;319:578.
8 +
Brower KF, Blow FL, Beresford TP, Fuelling C.  Anabolic-androgenic steroid dependence . J Clin Psychiatry. 1989;;50:31-33.
9 +
Haupt HA, Rovere GD.  Anabolic steroids: a review of the literature . Am J Sports Med. 1984;;12:469-484.
10 +
Wilson JD.  Androgen abuse by athletes . Endocr Rev. 1988;;9:181-199.
11 +
Lamb DR.  Anabolic steroids in athletics: how well do they work and how dangerous are they ? Am J Sports Med. 1984;;12:31-38.
12 +
Sklarek HM, Mantovani RP, Erens E, Heisler D, Niederman MS, Fein AM.  AIDS in a body-builder using anabolic steroids . N Engl J Med. 1984;;311:861-862.
13 +
Frankle MA, Cicero GJ, Payne J.  Use of androgenic anabolic steroids by athletes . JAMA. 1984;;252:482.
14 +
Alen M, Raahkila P, Reinila M, Vihko R.  Androgenic-anabolic steroid effects on serum thyroid, pituitary, and steroid hormones in athletes . Am J Sports Med. 1987;;15:357-361.
15 +
Santen RJ.  The testis . In: Felig P, Baxter JD, Broadus AE, Frohman LA, eds. Endocrinology and Metabolismn . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:821-905.
16 +
Martini L.  The 5 alpha-reduction of testosterone in the neuroendocrine structures: biochemical and physiological implications . Endocr Rev. 1982;;3:1-25.
17 +
Alen M, Reinila M, Vihko R.  Response of serum hormones to androgen administration in power athletes . Med Sci Sports Exerc. 1985;;17:354-359.
18 +
Martin JB, Reichlin S. Clinical Neuroendocrinology. 2nd ed. Philadelphia, Pa: FA Davis Co Publishers; 1987;.
19 +
Mayer M, Rosen F.  Interaction of glucocorticoids and androgens with skeletal muscle . Metabolism . 1977;;29:937-962.
20 +
Rance NE, Max SR.  Modulation of the cytosolic androgen receptor in striated muscle by sex steroids . Endocrinology. 1984;;115:862-866.
21 +
Reban RW, Yen SSC.  Endocrine rhythyms in gonadotropins and ovarian steroids with reference to reproductive processes . In: Krieger DT, ed. Reproductive Rhythyms . New York, NY: Raven Press; 1979;:259-298.
22 +
Miller NE, Hubert G, Hamilton JB.  Mental and behavioral changes following male hormone treatment of adult castration, hypogonadism and psychic impotence . Proc Soc Exp Biol Med. 1938;; 38:538-540.
23 +
Salmon UJ, Geist SH.  Effect of androgens upon libido in women . J Clin Endocrinol. 1943;; 3:235-238.
24 +
Altschule MD, Tillotson KJ.  The use of testosterone in the treatment of depressions . N Engl J Med. 1948;;239:1036-1038.
25 +
Woodbury DM.  Relation between the adrenal cortex and the central nervous system . Pharmacol Rev. 1958;;10:275-357.
26 +
Tyrrell JB, Baxter JD.  Glucocorticoid therapy . In: Felig P, Baxter JD, Broadus AB, Frohman LA, eds. Endocrinology and Metabolism. 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:788-817.
27 +
Freed DLJ, Banks AJ, Longson D, Burley DM.  Anabolic steroids in athletes: crossover double-blind trial on weight lifters . Br Med J. 1975;; 2:471-473.
28 +
Hervey GR.  Are athletes wrong about anabolic steroids ? Br J Sports Med. 1975;;9:74-77.
29 +
Lucking MT.  Steroid hormones in sports: special reference: sex hormones and their derivatives . Int J Sports Med. 1982;;3:65-67.
30 +
Taylor WN.  Are anabolic steroids for the long distance runner ? Ann Sports Med. 1984;;2:51-52.
31 +
Strauss RH, Wright JE, Finermin GA, Catlin DH.  Side effects of anabolic steroids in weight trained men . Phys Sports Med. 1983;;11( (12) ):87-96.
32 +
Strauss RH, Liggett MT, Lanese RR.  Anabolic steroid use and perceived effects in ten weight-trained women athletes . JAMA. 1985;;253:2871-2973.
33 +
Vest SA, Howard JE.  Clinical experiments with the use of male sex hormones . J Urol. 1938;;40;154-183.
34 +
Mirin SM, Weiss RD.  Affective illness in substance abusers . Psychiatr Clin North Am. 1986;;9:503-514.
35 +
Gawin FH, Ellinwood EH.  Cocaine and other stimulants: actions, abuse, and treatment . N Engl J Med. 1988;;318:1173-1182.
36 +
Pope HG, Katz DL.  Affective and psychotic symptoms associated with anabolic steroid use . Am J Psychiatry. 1988;;145:487-490.
37 +
Freinher JP, Alvarez W.  Androgen-induced hypomania . J Clin Psychiatry. 1985;;46:354-355.
38 +
Pope HG Jr, Katz DL.  Body builders psychosis . Lancet. 1987;;1:863.
39 +
Annitto J, Layman WA.  Anabolic steroids in acute schizophrenic episodes . J Clin Psychiatry. 1980;;41:143-144.
40 +
Kleber HD.  Epidemic cocaine abuse: America's present, Britain's future ? Br J Addict. 1988;; 83:1359-1371.
41 +
Gold MS, Redmond DE Jr, Kleber HD.  Noradrenergic hyperactivity in opiate withdrawal supported by clonidine reversal of opiate withdrawal . Am J Psychiatry. 1979;;136:100-102.
42 +
Linnoila M, Mefford I, Nutt D, Adinoff B.  Alcohol withdrawal and noradrenergic function . Ann Intern Med. 1987;;107:875-889.
43 +
Sherwin BB, Gelfand MM.  Differential symptom response to parenteral estrogen and/or androgen administration in the surgical menopause . Am J Obstet Gynecol. 1985;;151:153-160.
44 +
McLachlan RI, Healy DL, Burger HG.  The ovary: basic principles and concepts, B: clinical . In: Felig P, Baxter JD, Broadus AE, Frohman LA, eds. Endocrinology and Metabolism. 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:951-983.
45 +
Giannini AJ, Sullivan B, Sarachene J, Loiselle RH.  Clonidine in the treatment of premenstrual syndrome: a subgroup study . J Clin Psychiatry. 1988;;49:62-63.
46 +
Hamilton JA, Parry BL, Blumenthal SJ.  The menstrual cycle in context, I: affective syndromes associated with reproductive hormonal changes . J Clin Psychiatry. 1988;;49:474-480.
47 +
Hammarback S, Danber J, Backstrom T.  Relationships between symptom severity and hormone changes in women with pre-menstrual syndrome . J Clin Endocrinol Metab. 1989;;68:125-130.
48 +
Amatruda TT, Hurst MM, D'Esopo ND.  Certain endocrine and metabolic facets of the steroid withdrawal syndrome . J Clin Endocrinol Metab. 1965;;25:1207-1217.
49 +
Dixon RB, Christy NP.  On the various forms of corticosteroid withdrawal syndrome . Am J Med. 1980;;68:224-230.
50 +
Baxter JD, Tyrell JB.  The adrenal cortex . In: Felig P, Baxter JD, Broadus AE, Frohman LA, eds. Endocrinology and Metabolism. 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:511-650.
51 +
Facchinetti F, Martignoni E, Petraglia F, Sances MG, Nappi G, Genazzani AR.  Premenstrual fall of plasma beta-endorphin in patients with premenstrual syndrome . Fertil Steril. 1987;;47:570-573.
52 +
Ellingboe J, Veldhuis JD, Mendelson JH, Kuehle JL, Mello NK.  Effect of endogenous opioid blockage on the amplitude and frequency of LH secretion in normal men . J Clin Endocrinol Metab. 1982;;54:854-874.
53 +
Balzamo S, Migliari L, Sica V, et al.  The effect of androgen blockade on gonadotrophin release and LH response to naloxone . Clin Endocrinol Metab. 1987;;27:491-499.
54 +
Gawin FH, Kleber HD.  Abstinence symptomatology and psychiatric diagnosis in cocaine abusers . Arch Gen Psychiatry. 1986;;43:107-113.
55 +
Gawin FH, Kleber HD, Byck R, et al.  Desipramine facilitation of initial cocaine abstinence . Arch Gen Psychiatry. 1989;;46:117-121.
56 +
Buesching DP, Glasser ML, Frate DA.  Progression of depression in the prenatal and postpartum periods . Women Health. 1986;;11:61-78.
57 +
Kane FJ.  Postpartum disorders . In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. 4th ed. Baltimore, Md: Williams & Wilkins; 1985;:1238-1242.
58 +
Muse KN, Cetet NS, Futterman LA, Yen SC.  The premenstrual syndrome: effects of 'medical ovariectomy.' N Engl J Med. 1984;;311:1345-1349.
59 +
Catt KJ.  Molecular mechanisms of hormone action: control of target cell function by peptide, steroid, and thyroid hormones . In: Felig P, Baxter JD, Broadus AE, Frohman LA, eds. Endocrinology and Metabolism . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1987;:82-164.
60 +
Lave L, Kenigsberg D, Pescovitz OH, et al.  The treatment of familial precocious puberty with spironolactone and testolactone . N Engl J Med. 1989;;320:496-502.
61 +
Kleber HD, Kosten TB.  Naltrexone induction: psychologic and pharmacologic strategies . J Clin Psychiatry. 1984;;45:29-38.
62 +
Lukas SE, Mendelson JH.  Electroencephalographic activity and plasma ACTH during ethanolinduced euphoria . Biol Psychiatry. 1988;;23:141-148.
63 +
Rivier C, Bruhn T, Vale W.  Effect of ethanol on the hypothalamic-pituitary-adrenal axis in the rat: role of corticotropin-releasing factor (CRF) . J Pharmacol Exp Ther. 1984;;229:127-131.
64 +
Nikolarakis KE, Almeida OFX, Sirinathsinghji DJS, Herz A.  Concomitant changes in the in vitro and in vivo release of opioid peptides and luteinizing hormone-releasing hormone from the hypothalamus following blockade of receptors for corticotropin-releasing factor . Neuroendocrinology. 1988;;47:545-550.
65 +
Gold PW, Goodwin FK, Chrousos GP.  Clinical and biochemical manifestations of depression: relation to the neurobiology of stress . N Engl J Med. 1988;;319:413-420.
66 +
Kendall DA, Stancel GM, Enna SJ.  Imipramine: Effects of ovarian steroids on modifications in serotonin receptor binding . Science. 1981;;211:1183-1185.
67 +
Kendall DA, Stancel GM, Enna SJ.  The influence of sex hormones on antidepressant-induced alterations in neurotransmitter receptor binding . J Neurosci. 1982;;2:354-360.
68 +
Heninger GR, Charney DS.  Mechanism of action of antidepressant treatments: implications for the etiology and treatment of depressive disorders . In: Meltzer HY, ed. Psychopharmacology: The Third Generation of Progress . New York, NY: Raven Press; 1987;:535-544.
69 +
Kleber HD, Topazian M, Gaspari J, Riordan CE, Kosten T.  Clonidine and naltrexone in the outpatient treatment of heroin withdrawal . Am J Drug Alcohol Abuse. 1987;;13:1-17.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems