SUN-488 Opioid Induced Pituitary Dysfunction

The most common endocrinopathy resulting from chronic opioid use is suppression of all axes, primarily the HPG Axis and the HPA Axis (1). Systematic studies of GH deficiency have not been done. Studies have shown an increase in PRL in patients receiving methadone and morphine. There have been conflicting studies on the effect of opioids on the HPT Axis. Chronic opioid use is associated with osteoporosis; we do not know if it is a direct effect of opioids on bone or secondary to hypogonadism. We do not know the prevalence of hormonal derangements in patients on opioids. We hypothesized that most patients taking daily opioids have not been screened for pituitary dysfunction, that patients taking daily opioids for more than 3 months would have secondary hypogonadism, GH deficiency, AI, thyroid dysfunction, prolactin elevation, and osteoporosis/osteopenia. We reviewed 120 charts of male patients at McGuire Richmond VA between the ages of 18-88 taking daily opioids for over 3 months with a diagnosis of non-malignant pain. We excluded 68 charts for the presence of active cancer (n = 25), taking opioids for less than 3 months (n = 22), and CKD 3 (n = 10). Of the 52 patients that met the inclusion criteria, 2 patients had total testosterone levels tested (3.84% of total patients; average total testosterone was 275 ng/dL), 1 patient had free and bioavailable testosterone levels tested (1.92% of total patients), 6 patients had FSH and LH levels tested (11.53% of total patients; average FSH was 8.34 mIU/ml in the oxycodone group, 3.35 mIU/ml in the tramadol group and 0.36 mIU/ml in the fentanyl/hydromorphone/oxycodone group; average LH was 4.87 mIU/ml in the oxycodone group 2.36 mIU/ml in the tramadol group and 0.18 mIU/ml in the fentanyl/hydromorphone/oxycodone group), no patients had IGF-1 or ACTH tested, 1 patient had cortisol tested (1.92%), 1 patient had prolactin tested (1.92%; normal). 39 (75%) patients underwent a screening with a TSH value and 20 (40.38%) of patients underwent a screening for FT4. Of the TSH values, only one was elevated, in a patient on morphine and oxycodone. Of the FT4 values, only 2 were suppressed and none were elevated. Only 13 of the 52 patients had BMD studies within a year of taking opioids for 3 months; 7 had osteopenia, 6 had normal studies, and none had osteoporosis. Given the paucity of screening observed, providers need education about screening patients on opioid therapy for symptoms and biochemical signs of hypogonadism and adrenal insufficiency. Providers should counsel patients about suppressive side effects of opioids on the HPG and HPA axes. Providers should consider non-opioid therapies for pain to avoid causing endocrinopathies. Furthermore, over half of the patients with BMD studies showed osteopenia; patients on 3 months of opioids should be considered for osteoporosis screening. 1) Gudin, J., Laitman, A., and Nalamachu, S. Opioid related endocrinopathy. Pain Medicine 2015;S9-S15