Abdominal Hypertrophy Syndrome: Characteristics and Potential Pathophysiology.

Abdominal hypertrophy syndrome, known as steroid gut, is an uncommon condition affecting bodybuilders and athletes engaged in prolonged usage of growth hormone (GH), insulin, and other anabolic agents. The condition is more commonly known in the professional bodybuilding community as Palumboism, named after David Palumbo, an American bodybuilder. It is characterized by significant enlargement and distension of the abdomen. Precise pathophysiological mechanisms and underlying causes of Palumboism have yet to be fully understood. The primary objective of this study is to conduct a comprehensive literature review of the condition and explore the pathophysiology and possible treatment modalities. We aim to contribute to the existing knowledge of Palumboism and lay the foundation for clinical and surgical management. A literature review was conducted using PubMed and other sources. Specific keywords, such as "palumboism," "bodybuilder gut," "steroid gut," "HGH gut," "insulin gut," "bubble gut," "muscle gut," "abdominal distension," "abdominal organomegaly," "visceral adiposity," "abdominal obesity," "anabolic steroids," and "growth hormone," were employed to retrieve relevant articles. The inclusion criteria focused on studies that investigated the pathophysiology, clinical presentation, and management of Palumboism. A total of 1,222 studies were identified through the search criteria, of which 451 were screened, 33 were assessed for eligibility, and 30 studies were included in the final review. Literature review revealed that no peer-reviewed studies dedicated to Palumboism, underscoring the insufficient research conducted in this area. The available anecdotal data suggest that the prolonged use of high-dose anabolic steroids, particularly human GH and insulin, may contribute to the development of Palumboism. Several potential mechanisms have been proposed, including visceral adiposity, organomegaly, and altered collagen synthesis. Given the dearth of available research on Palumboism, a comprehensive understanding of this condition is yet to be established. Further studies are warranted to elucidate the pathophysiology, establish diagnostic criteria, and explore treatment options for affected individuals.