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Opioid-induced endocrinopathies

Athanasios Fountas1, Stan Van Uum2, Niki Karavitaki1

  • 1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

The Lancet. Diabetes & Endocrinology
|October 19, 2019
PubMed

Insights

Opioid use can disrupt hormone regulation, causing underdiagnosed endocrine issues like hypogonadism and adrenal dysfunction. Early assessment and hormone replacement are key for managing these opioid-induced endocrinopathies.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Public Health

Background:

  • Opioid use is a global epidemic with significant endocrine consequences.
  • Opioid-induced endocrinopathies are often underdiagnosed due to patient and clinician factors.
  • Key endocrine effects include hypogonadism, hypothalamo-pituitary-adrenal axis inhibition, and bone health issues.

Purpose of the Study:

  • To review the endocrine effects of opioid use.
  • To highlight the underdiagnosis of opioid-induced endocrinopathies.
  • To discuss diagnostic and management strategies.

Main Methods:

  • Literature review of opioid effects on the endocrine system.
  • Analysis of recognized and potential hormonal disruptions.
  • Discussion of clinical assessment and management approaches.

Main Results:

  • Hypogonadism is the most recognized opioid-induced endocrinopathy.
  • Inhibitory effects on the hypothalamo-pituitary-adrenal axis and bone health are significant.
  • Clinically relevant thyroid dysfunction and hyperprolactinemia are less consistently identified.

Conclusions:

  • Assessment of gonadal, adrenal function, and bone health is recommended for opioid users.
  • Management involves dose reduction/discontinuation and hormone replacement therapy.
  • Further research is needed for evidence-based guidelines on diagnosis and management.

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