Division of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN.
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2018 Jul;93(7):937-944. doi: 10.1016/j.mayocp.2018.04.010.
One in 10 Americans experience chronic pain. Although opioids do play a role in the management of pain, long-term opioid use may lead to adverse effects. Endocrine-related adverse effects have been described but remain poorly recognized. Opioid-induced adrenal insufficiency occurs because of suppression of hypothalamic-pituitary-adrenal communication and may be challenging to diagnose but has been reported in 9% to 29% of patients receiving long-term opiate therapy. Little data exist to guide case detection and patient management. Treatment includes cessation of opiates (the inciting factor) if possible and glucocorticoid replacement.
十分之一的美国人患有慢性疼痛。虽然阿片类药物在疼痛管理中确实发挥了作用，但长期使用阿片类药物可能会导致不良反应。已经描述了与内分泌相关的不良反应，但仍未得到充分认识。阿片类药物引起的肾上腺功能不全是由于下丘脑-垂体-肾上腺通讯受到抑制而发生的，可能难以诊断，但在接受长期阿片类药物治疗的患者中，有 9%至 29%的患者报告了这种情况。目前几乎没有数据可以指导病例检测和患者管理。治疗包括如果可能的话停止使用阿片类药物（诱发因素）和糖皮质激素替代治疗。
