Opioid-induced hypoadrenalism resulting in fasting hypoglycaemia

Area of Science:

• Endocrinology
• Pharmacology

Background:

• Hollow visceral myopathy can complicate patient management.
• Opioid analgesia is frequently used for pain management in hospital settings.

Observation:

• An 18-year-old woman with hollow visceral myopathy developed small-bowel obstruction requiring high-dose opioids.
• She experienced two episodes of fasting hypoglycemia despite adjusted carbohydrate intake.
• Investigations revealed low morning cortisol and inappropriately low Adrenocorticotropic hormone (ACTH), indicative of secondary adrenal insufficiency.

Findings:

• Diagnosis of secondary adrenal insufficiency was confirmed.
• The short Synacthen test suggested acute rather than chronic ACTH deficiency.
• Adrenal function recovered upon cessation of opioid therapy, suggesting opioid-induced hypoadrenalism.

Implications:

• Opioid-induced hypoadrenalism is a potentially under-recognized clinical entity.
• This case highlights a link between opioid use, secondary adrenal insufficiency, and fasting hypoglycemia.
• Awareness of this adverse effect is crucial for patient safety, especially with commonly prescribed opioids.