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Opioids and pituitary function: expert opinion.

Mônica R Gadelha1,2,3, Niki Karavitaki4,5,6, Jeffrey Fudin7,8,9,10

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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.

Keywords:
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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.