CLINICAL PRESENTATION AND OUTCOMES OF OPIOID INDUCED ADRENAL INSUFFICIENCY.
Endocr Pract. 2020 Jun 23;:
Authors: Li T, Donegan D, Michael Hooten W, Bancos I
OBJECTIVE: Opioid-induced adrenal insufficiency (OIAI) may develop in patients treated with chronic opioids due suppression of the hypothalamic-pituitary-adrenal axis. Our objective was to describe clinical manifestations, biochemical presentation and clinical course of OIAI. METHODS: A retrospective study of adults diagnosed with OIAI between 2006 and 2018 at an academic center. Opioid daily dose was converted into morphine mg equivalent (MME). RESULTS: Forty patients (n=29, 73% women) taking chronic opioids at a daily median MME dose of 105 (60-200) mg and median duration of 60 (3-360) months were diagnosed with OIAI. Patients reported fatigue (n=29, 73%), musculoskeletal pain (n=21, 53%), and weight loss (n=17, 53%) for a median of 12 (1-132) months prior to diagnosis and only 7.5% (n=3) patients were identified with OIAI through case detection. Biochemical diagnosis of OIAI was based on 1) low morning cortisol, baseline ACTH and/or DHEAS in 59% (n=26) patients or 2) abnormal cosyntropin stimulation test (CST) in 41% (n=14) patients. With glucocorticoid replacement, 16/23 (70%) patients with available follow up experienced improvement in symptoms. Opioids were tapered or discontinued in 15 patients, of whom 10 were followed for adrenal function of which 7 (70%) recovered from OIAI. CONCLUSION: Minimum daily MME in patients diagnosed with OIAI was 60 mg/day. OIAI causes significant morbidity and recognition requires a high level of clinical suspicion. Appropriate glucocorticoid treatment led to improvement of symptoms in 70%. Resolution of OIAI occurred following opioid cessation or reduction.
PMID: 32576041 [PubMed - as supplied by publisher]