University of Missouri- Kansas City School of Medicine, Saint Luke's Hospital of Kansas City, 64111, USA.
Curr Pharm Des. 2012;18(37):6070-8. doi: 10.2174/138161212803582414.
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.
阿片类药物是已知最古老和应用最广泛的镇痛药之一。在过去几十年中，阿片类药物的应用范围不断扩大，特别是在治疗慢性非恶性疼痛方面。这种阿片类药物使用的增加伴随着越来越多的阿片类药物相关内分泌疾病的认识。这可能是在摄入肠内、肠外或鞘内阿片类药物后发生的。阿片类药物相关的内分泌疾病主要包括下丘脑-垂体-性腺轴或下丘脑-垂体-肾上腺轴功能障碍，并可能表现为性腺功能减退、肾上腺功能障碍和其他激素紊乱的症状。此外，阿片类药物相关的内分泌功能障碍可能与骨质疏松症和情绪障碍（包括抑郁）等疾病同时发生。疼痛敏感性的不良变化，如阿片类药物引起的痛觉过敏和阿片类药物镇痛作用的降低，也可能是慢性阿片类药物消耗的潜在后果。迄今为止，很少有研究能够确定多大剂量或治疗持续时间的阿片类药物暴露可能使患者易患阿片类药物相关内分泌疾病。本文将回顾目前有关阿片类药物相关内分泌疾病的文献，并为阿片类药物相关内分泌疾病及其其他不良影响的评估、监测和管理提供建议。
