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The Hiccup Reflex Arc and Persistent Hiccups with High-dose Anabolic Steroids: Is the Brainstem the Steroid-Responsive Locus?

Dickerman, Rob D.; Jaikumar, Sivakumar

Brief Report

Hiccups have been classified as a neurologic reaction triggered by a multitude of factors. There are only a few reports of persistent hiccups associated with oral and intravenous corticosteroid use in the medical literature. It has been proposed that corticosteroids lower the threshold for synaptic transmission in the midbrain and directly stimulate the hiccup reflex arc. There is a recent report of progesterone-induced hiccups, which were thought to occur secondary to the glucocorticoid-like effects of progesterone on the brainstem. We report the first case of anabolic steroid-induced hiccups occurring in an elite power lifter. The hiccups occurred within 12 hours of the individual increasing his doses of oral anabolic steroids and persisted for 12 consecutive hours until medical attention was sought. In this report the pathophysiology of anabolic steroid-induced hiccups is discussed, and the postulated relationships of steroids and the hiccup reflex arc reviewed.

Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA

Address correspondence and reprint requests to Rob D. Dickerman, Department of Neurosurgery, Long Island Jewish Medical Center, 410 Lakeville Rd., Suite 210, New Hyde Park, NY 11040, USA.

© 2001 Lippincott Williams & Wilkins, Inc.