Controversial supreme leader of North Korea, Kim Jong-un has been under the media spotlight since he assumed power, after his father’s death. Back in 2014, Kim was alleged to have executed his uncle with a flame-thrower. Kim was also accused of assassinating his own half-brother earlier this year. Recently, the ruthless supremo caught media’s attention again as he fired a missile over the island of Hokkaido – claiming it is the “first step to containing Guam.”

An article recently published by Page Six reported a widespread speculation in the US medical community that Kim has been receiving high-dose steroids for the treatment for gout. According to the doctors, Kim’s recent aggressive moves, including his plan to “contain Guam”, are resulted from “roid rage” – a serious, yet inconclusive side effect of corticosteroids.

Long-term treatment of high-dose steroids for gout is rare

Corticosteroids are drugs to treat inflammatory illnesses, including gout. However, corticosteroids can cause serious side effects if consumed long-term. Side effects include high blood pressure, stomach ulcers and psychological problems, such as depression and mood swings.

“Steroid treatments were often used to relieve acute pain in joints caused by gout, which is known as the disease of epicureans and kings. This fellow could be manifesting “roid rage” as part of its side effects,” remarks Dr Rock Positano of the Hospital for Special Surgery.

Kim's love for food is well known, with former chefs of his father Kim Jong-Il reporting dining tables laden with steak, shark fin soup and champagne. The 33-year-old is said to be particularly obsessed with Emmenthal cheese, which he discovered during his years studying at a Swiss boarding school.

“When steroids circulating in our blood enter our brain, they may interfere with our neurotransmitters, including dopamine and serotonin, and consequently affect our mood and behavior,” Professor Vivian Wing-Yan Lee, Associate Professor at The Chinese University of Hong Kong (CUHK)’s School of Pharmacy, explains in an article published by Ming Pao.

“The situation of steroid rage, or generally known as “roid rage”, may occur only if a patient takes a high dosage of steroid for a very long time,” emphasises Lee. “Patients may become suspicious, jealous, vulnerable to stimulation and provocation – causing them to hallucinate; thus, influencing their judgment and even exerting violence on others.”

Concerning whether gout patients would appear manic upon receiving steroid treatment, Lee says that "these are very extreme cases. Even if the patient suffers from serious gout, steroids are only used for a short period of time to suppress inflammation. Rarely do patients take high-dose steroids for long."

Does “roid rage” exist?

In a June interview with WebMD, Gary Wadler, MD, characterised “roid rage” as a form of loss of impulse control. It provokes overreactions via a stimulus that normally doesn't produce such a severe reaction.

“It's really an extreme of a spectrum of kind of behavioural things that you see with anabolic steroids. Although it’s been implicated in a number of murders, it may unmask an underlying psychiatric disorder of the individual who is exposed to this category of drugs,” said Wadler.

The evidence of “roid rage” is inconclusive. According to a study conducted by New England Journal of Medicine (NEJM), “roid rage” does not seem to exist. Rather, the study produced conflicting results, as most of the anabolic steroid users did not experience “roid rage” or any other symptoms closely resembling it. Yet, placebo effects occur to some anabolic steroid users, who generally have an understanding of the effects. MIMS

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