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Adrenal insufficiency in acute oral opiate therapy

Opiate drugs such as morphine are in extensive use for pain relief and palliation. It is well established that these drugs can cause changes in endocrine function, but such effects are not always sufficiently appreciated in clinical practice, especially in relation to the hypothalamic–pituitary–adre...

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Autores principales: Policola, Caterina, Stokes, Victoria, Karavitaki, Niki, Grossman, Ashley
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965279/
https://www.ncbi.nlm.nih.gov/pubmed/24683482
http://dx.doi.org/10.1530/EDM-13-0071
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author Policola, Caterina
Stokes, Victoria
Karavitaki, Niki
Grossman, Ashley
author_facet Policola, Caterina
Stokes, Victoria
Karavitaki, Niki
Grossman, Ashley
author_sort Policola, Caterina
collection PubMed
description Opiate drugs such as morphine are in extensive use for pain relief and palliation. It is well established that these drugs can cause changes in endocrine function, but such effects are not always sufficiently appreciated in clinical practice, especially in relation to the hypothalamic–pituitary–adrenal (HPA) axis. Herein, we report on an 18-year-old man who was diagnosed with a slipped left femoral epiphysis following a long history of pain in his leg. On examination, he was thought to look relatively young for his age and therefore the orthopaedic surgeons arranged an endocrine assessment, which showed an undetectable concentration of serum cortisol and a suppressed concentration of testosterone; therefore, he was referred urgently with a diagnosis of hypopituitarism. We elicited a history that he had been treated with opiate analgesics for 3 days at the time of his original blood tests. Full endocrine assessment including a short Synacthen test revealed that he now had normal adrenal and pituitary function. We conclude that his morphine therapy had caused profound suppression of his HPA and pituitary–gonadal axes and suggest that clinicians should be aware of these significant changes in patients on even short-term opiate therapy. LEARNING POINTS: Therapy with opiates is the standard therapy for severe acute and chronic pain. Such drugs cause profound changes in endocrine function. Importantly, opiates suppress the HPA axis at a central level. Short-term therapy with morphine could be the cause of biochemical adrenocortical insufficiency. Morphine and related drugs also suppress the pituitary–gonadal axis. After discontinuation of therapy with such drugs, adrenal function improves.
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spelling pubmed-39652792014-03-28 Adrenal insufficiency in acute oral opiate therapy Policola, Caterina Stokes, Victoria Karavitaki, Niki Grossman, Ashley Endocrinol Diabetes Metab Case Rep Unusual Effects of Medical Treatment Opiate drugs such as morphine are in extensive use for pain relief and palliation. It is well established that these drugs can cause changes in endocrine function, but such effects are not always sufficiently appreciated in clinical practice, especially in relation to the hypothalamic–pituitary–adrenal (HPA) axis. Herein, we report on an 18-year-old man who was diagnosed with a slipped left femoral epiphysis following a long history of pain in his leg. On examination, he was thought to look relatively young for his age and therefore the orthopaedic surgeons arranged an endocrine assessment, which showed an undetectable concentration of serum cortisol and a suppressed concentration of testosterone; therefore, he was referred urgently with a diagnosis of hypopituitarism. We elicited a history that he had been treated with opiate analgesics for 3 days at the time of his original blood tests. Full endocrine assessment including a short Synacthen test revealed that he now had normal adrenal and pituitary function. We conclude that his morphine therapy had caused profound suppression of his HPA and pituitary–gonadal axes and suggest that clinicians should be aware of these significant changes in patients on even short-term opiate therapy. LEARNING POINTS: Therapy with opiates is the standard therapy for severe acute and chronic pain. Such drugs cause profound changes in endocrine function. Importantly, opiates suppress the HPA axis at a central level. Short-term therapy with morphine could be the cause of biochemical adrenocortical insufficiency. Morphine and related drugs also suppress the pituitary–gonadal axis. After discontinuation of therapy with such drugs, adrenal function improves. Bioscientifica Ltd 2014-01-01 2014 /pmc/articles/PMC3965279/ /pubmed/24683482 http://dx.doi.org/10.1530/EDM-13-0071 Text en © 2014 The authors This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by/3.0/deed.en_GB) .
spellingShingle Unusual Effects of Medical Treatment
Policola, Caterina
Stokes, Victoria
Karavitaki, Niki
Grossman, Ashley
Adrenal insufficiency in acute oral opiate therapy
title Adrenal insufficiency in acute oral opiate therapy
title_full Adrenal insufficiency in acute oral opiate therapy
title_fullStr Adrenal insufficiency in acute oral opiate therapy
title_full_unstemmed Adrenal insufficiency in acute oral opiate therapy
title_short Adrenal insufficiency in acute oral opiate therapy
title_sort adrenal insufficiency in acute oral opiate therapy
topic Unusual Effects of Medical Treatment
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965279/
https://www.ncbi.nlm.nih.gov/pubmed/24683482
http://dx.doi.org/10.1530/EDM-13-0071
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