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.

Abstract

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.
 

Related posts:

Must-read article: everything you didn’t realize you wanted to know about narcotic bowel syndrome

Important new concept: opioid-induced hyperalgesia

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