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Opioids and pituitary function: expert opinion.
Mônica R Gadelha1,2,3, Niki Karavitaki4,5,6, Jeffrey Fudin7,8,9,10
1Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Pituitary
|January 23, 2022
Summary
Chronic opioid use can suppress the hypothalamic-pituitary axes, leading to hypogonadism, adrenal insufficiency, and hyperprolactinemia. Early evaluation and management are crucial for patients on long-term opioid therapy.
Area of Science:
- Endocrinology
- Pharmacology
- Public Health
Background:
- Opioid use has surged, posing significant public health challenges due to addiction and adverse outcomes.
- The impact of long-term opioid use on the hypothalamic-pituitary axes is often overlooked by healthcare professionals.
- Opioid-induced endocrine dysfunction affects vital hormonal pathways, impacting patient health.
Purpose of the Study:
- To review the effects of opioids on hypothalamic-pituitary-target gland function.
- To discuss the clinical implications of opioid-induced endocrine changes.
- To provide strategies for diagnosing and managing these effects.
Main Methods:
- Literature review by experts in hypothalamic-pituitary disorders and opioid pharmacology.
- Analysis of recent publications on opioid-induced endocrine effects.
- Consideration of diagnostic and management strategies.
Main Results:
- Opioid use can suppress the hypothalamic-pituitary axes, causing hypogonadotropic hypogonadism, central adrenal insufficiency, and hyperprolactinemia.
- These endocrine manifestations are frequently underestimated, underdiagnosed, and inadequately treated.
- Limited data exists on diagnostic testing and hormone replacement efficacy, with a lack of prospective studies.
Conclusions:
- Patients on chronic opioid therapy should be informed about potential risks of hypogonadism, adrenal insufficiency, and hyperprolactinemia.
- Clinical and biochemical evaluation for these endocrine disorders is recommended for patients on long-term opioids.
- Current expert guidelines should be utilized for the diagnosis and treatment of opioid-induced endocrine dysfunction.
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