Albany Medical College, Albany, NY, USA.
Pain Physician. 2012 Jul;15(3 Suppl):ES145-56.
Opioid therapy is one of the most effective forms of analgesia currently in use. In the past few decades, the use of opioids as a long-term treatment for chronic pain has increased dramatically. Accompanying this upsurge in the use of long-term opioid therapy has been an increase in the occurrence of opioid associated endocrinopathy, most commonly manifested as an androgen deficiency and therefore referred to as opioid associated androgen deficiency (OPIAD). This syndrome is characterized by the presence of inappropriately low levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) leading to inadequate production of sex hormones, particularly testosterone. Symptoms that may manifest in patients with OPIAD include reduced libido, erectile dysfunction, fatigue, hot flashes, and depression. Physical findings may include reduced facial and body hair, anemia, decreased muscle mass, weight gain, and osteopenia or osteoporosis. Additionally, both men and women with OPIAD may suffer from infertility. While the literature regarding OPIAD remains limited, it is apparent that OPIAD is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized. OPIAD can have a significant negative impact on the the quality of life of opioid users, and clinicians should anticipate the potential for its occurrence whenever long-term opioid prescribing is undertaken. Once diagnosed, treatment for OPIAD may be offered utilizing a number of androgen replacement therapy options including a variety of testosterone preparations and, for female patients with OPIAD, dehydroepiandrosterone (DHEA) supplementation. Follow-up evaluation of patients receiving androgen replacement therapy should include a review of any unresolved symptoms of hypogonadism, laboratory evaluation, and surveillance for potential adverse effects of androgen replacement therapy including prostate disease in males.:
阿片类药物治疗是目前最有效的镇痛形式之一。在过去的几十年中，阿片类药物作为慢性疼痛的长期治疗方法的使用急剧增加。伴随着长期阿片类药物治疗使用的增加，阿片类药物相关内分泌病的发生也有所增加，最常见的表现为雄激素缺乏，因此被称为阿片类药物相关雄激素缺乏（OPIAD）。该综合征的特征是促性腺激素（卵泡刺激素和黄体生成素）水平异常降低，导致性激素，特别是睾酮的产生不足。患有 OPIAD 的患者可能出现的症状包括性欲降低、勃起功能障碍、疲劳、热潮红和抑郁。身体检查可能包括面部和体毛减少、贫血、肌肉量减少、体重增加、骨质疏松或骨量减少。此外，患有 OPIAD 的男性和女性都可能不育。虽然关于 OPIAD 的文献仍然有限，但很明显，OPIAD 在慢性阿片类药物使用者中越来越普遍，但往往未被发现。OPIAD 会对阿片类药物使用者的生活质量产生重大负面影响，临床医生在开始长期阿片类药物处方时应预测其发生的可能性。一旦确诊，可通过多种雄激素替代疗法（包括多种睾酮制剂）为 OPIAD 患者提供治疗，对于患有 OPIAD 的女性患者，可使用脱氢表雄酮（DHEA）补充剂。接受雄激素替代治疗的患者的随访评估应包括回顾任何未解决的性腺功能减退症状、实验室评估以及监测雄激素替代治疗的潜在不良反应，包括男性的前列腺疾病。
