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A Closer Look at Opioid-Induced Adrenal Insufficiency: A Narrative Review
Flaminia Coluzzi1,2, Jo Ann K LeQuang3, Salvatore Sciacchitano4,5
1Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy.
International Journal of Molecular Sciences
|March 11, 2023
Summary
Opioid-associated adrenal insufficiency (OIAI) is a common but poorly understood condition linked to long-term opioid use. Early diagnosis and management are crucial to prevent adrenal crisis, with resolution occurring upon opioid cessation.
Area of Science:
- Endocrinology
- Pharmacology
- Internal Medicine
Background:
- Opioid-associated adrenal insufficiency (OIAI) is a frequent endocrine complication of long-term opioid therapy.
- OIAI is often overlooked by non-endocrine specialists and differs from primary adrenal insufficiency.
- Risk factors beyond chronic opioid use remain largely unknown.
Purpose of the Study:
- To highlight the prevalence and underdiagnosis of OIAI.
- To emphasize the potential dangers of OIAI, including adrenal crisis.
- To underscore the need for improved diagnostic and treatment guidelines.
Main Methods:
- Review of existing literature on OIAI.
- Discussion of diagnostic challenges, including morning cortisol testing limitations.
- Analysis of treatment strategies and the impact of opioid cessation.
Main Results:
- OIAI affects a significant number of patients on chronic opioid therapy.
- Current diagnostic criteria lack established cutoff values, leading to an estimated 10% diagnosis rate.
- Adrenal crisis is a serious potential complication of undiagnosed OIAI.
Conclusions:
- OIAI requires greater clinical awareness and understanding.
- Enhanced diagnostic protocols and clear treatment guidelines are urgently needed.
- OIAI is treatable and reversible with opioid cessation, necessitating better management strategies.
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