Opioids can cause endocrine dysfunction
February 26, 2013, 4:12 pm
The Effect of Opioid Therapy on Endocrine Function. Brennan MJ. Am J Med 2013 Mar;126:S12-S18.
In recent months, TPR has discussed recent medical literature detailing various averse effects of chronic opioid therapy, including narcotic bowel syndrome and opioid-induced hyperalgesia, Additional adverse effects include sedation, immune suppression, and worsening sleep apnea. This well done review article provides a helpful outline of yet another complication: depressed endocrine function.
The author notes that opioids affect 2 endocrine pathways. The first pathway is the hypothalamic-pituitary-gonadal axis. Opioids decrease secretion of gonadotropin-releasing hormone by the hypothalamus, directly depress pituitary function and also impair sex -hormone production by the ovaries and testes. The end result is diminished libido, fertility, sexual function, energy, bone density, and muscle mass.
The second pathway is the hypothalamic-pituiary-adrenal axis, where opioids reduce levels of corticotropin-releasing hormone, ACTH, cortisol, and adrenal sex-hormones such as DHEA. The resulting adrenal insufficiency can be clinically significant.
The author makes recommendations for monitoring and treating opioid-induced endocrine insufficiency. IMPORTANT NOTE: Dr. Brennan discloses financial relationships with a number of medical and pharmaceutical companies, some of which make endocrine monitoring tests and hormone replacement products. Tis should be kept in mind when reading his “Monitoring and Treatment” section.