Title:Non-Analgesic Effects of Opioids: Opioids and the Endocrine System
VOLUME: 18 ISSUE: 37
Author(s):Jennifer A. Elliott, Susan E. Opper, Sonali Agarwal and Eugene E. Fibuch
Affiliation:University of Missouri- Kansas City School of Medicine, Saint Luke’s Hospital of Kansas City, 215 W. 43rd Street, Kansas City, MO 64111, USA.
Keywords:Opioids, endocrine, hypogonadism, testosterone, androgens, osteoporosis, depression, hyperalgesia, dose, opioid-associated endocrinopathy.
Abstract:Opioids are among the oldest known and most widely used analgesics. The application of opioids has expanded over the last
few decades, especially in the treatment of chronic non-malignant pain. This upsurge in opioid use has been accompanied by the increasingly
recognized occurrence of opioid-associated endocrinopathy. This may arise after exposure to enteral, parenteral, or neuraxial
opioids. Opioid-associated endocrinopathy consists primarily of hypothalamic-pituitary-gonadal axis or hypothalamic-pituitary-adrenal
axis dysfunction and may manifest with symptoms of hypogonadism, adrenal dysfunction, and other hormonal disturbances. Additionally,
opioid related endocrine dysfunction may be coupled with such disorders as osteoporosis and mood disturbances including depression.
Undesirable changes in pain sensitivity such as opioid-induced hyperalgesia, and reduced potency of opioid analgesia may also be
potential consequences of chronic opioid consumption. Few studies to date have been able to establish what degree of opioid exposure, in
terms of dose or duration of therapy, may predispose patients to opioid-associated endocrinopathy. This article will review the currently
available literature concerning opioid-associated endocrinopathy and will provide recommendations for the evaluation, monitoring, and
management of opioid-associated endocrinopathy and its other accompanying undesired effects.
