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阿片类药物诱导的上腺功能不全:诊断和管理方面的考虑
Erica Patel1, Anat Ben-Shlomo1,2
1Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Frontiers in endocrinology
|March 13, 2024
概括
服用阿片类药物可以抑制下丘脑-垂体-上腺 (HPA) 轴,导致上腺功能不充分. 对于长期接受阿片类药物治疗的患者来说,早期诊断和管理至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
- 临床医学 临床医学
背景情况:
- 增加的阿片类药物使用带来了重大的健康挑战.
- 对内分泌系统的阿片类药物影响,特别是皮质醇调节,未被充分认识到.
- 慢性阿片类药物使用可以破坏下丘脑-垂体-上腺 (HPA) 轴.
研究的目的:
- 审查阿片类药物对内分泌系统的影响,重点关注上腺功能.
- 讨论阿片类药物诱导上腺功能不全 (OAI) 的诊断挑战和管理策略.
- 要突出进一步研究阿片类药物-HPA轴相互作用的需要.
主要方法:
- 审查关于阿片类药物使用和上腺功能不全的现有文献.
- 对OAI的诊断挑战和可用的测试方法的分析.
- 讨论OAI目前的治疗建议.
主要成果:
- 阿片类药物可能会导致临床上显著的上腺功能不全,特别是在更高剂量和更长时间使用的情况下.
- 由于阿片类药物使用和潜在疼痛条件的重叠症状,诊断OAI很困难.
- 对于上腺功能不全的传统诊断分析需要在接受阿片类药物治疗的患者中进行进一步的研究.
结论:
- 高度的临床怀疑对于早期OAI诊断至关重要.
- 葡萄糖皮质体替代剂 (例如,皮质素) 是主要的治疗方法,除了减少阿片类药物剂量外.
- 需要持续监测皮质醇水平和HPA轴恢复.
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