Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
Neurosurgical Department, ULSS2 Treviso Hospital, University of Padua, Treviso, Italy.
J Endocrinol Invest. 2018 Dec;41(12):1377-1388. doi: 10.1007/s40618-018-0964-3. Epub 2018 Oct 20.
The use of opioids in patients with chronic non-cancer pain is common and can be associated with opioid-induced androgen deficiency (OPIAD) in men. This review aims to evaluate the current literature regarding the prevalence, clinical consequence and management of OPIAD.
A database search was performed in Medline, Embase and Cochrane using terms such as "analgesics", "opioids" and "testosterone". Relevant literature from January 1969 to March 2018 was evaluated.
The prevalence of patients with OPIAD ranges from 19 to 86%, depending on the criteria for diagnosis of hypogonadism. The opioid-induced suppression of gonadotropin-releasing and luteinizing hormones represents the main important pathogenetic mechanisms. OPIAD has significant negative clinical consequences on sexual function, mood, bone density and body composition. In addition, OPIAD can also impair pain control leading to hyperalgesia, which can contribute to sexual dysfunction and mood impairment.
OPIAD is a common adverse effect of opioid treatment and contributes to sexual dysfunction, impairs pain relief and reduces overall quality of life. The evaluation of serum testosterone levels should be considered in male chronic opioid users and the decision to initiate testosterone treatment should be based on the clinical profile of individuals, in consultation with the patient.
慢性非癌痛患者中阿片类药物的使用较为常见，可能会导致男性出现阿片类药物诱导的雄激素缺乏（opioid-induced androgen deficiency，OPIAD）。本综述旨在评估有关 OPIAD 的患病率、临床后果和管理的现有文献。
使用“analgesics”、“opioids”和“testosterone”等术语，在 Medline、Embase 和 Cochrane 数据库中进行检索。评估了 1969 年 1 月至 2018 年 3 月的相关文献。
OPIAD 的患病率因诊断性腺功能减退症的标准而异，范围为 19%至 86%。促性腺激素释放激素和黄体生成素的阿片类药物抑制是主要的重要发病机制。OPIAD 对性功能、情绪、骨密度和身体成分有显著的负面影响。此外，OPIAD 还会损害疼痛控制，导致痛觉过敏，这可能导致性功能障碍和情绪障碍。
OPIAD 是阿片类药物治疗的常见不良反应，会导致性功能障碍、疼痛缓解受损和整体生活质量下降。应考虑在男性慢性阿片类药物使用者中评估血清睾酮水平，并且应根据个体的临床特征并与患者协商来决定是否开始睾酮治疗。
