Department of Endocrinology and Diabetes, Indiana University School of Medicine, Indiana, USA.
Curr Opin Endocrinol Diabetes Obes. 2019 Jun;26(3):133-138. doi: 10.1097/MED.0000000000000474.
Despite the declaration of an opioid epidemic, opioid use remains prevalent. Side-effects of chronic opioid use continue to be problematic. Opioid-induced endocrinopathies have been well documented, yet opioid-induced adrenal insufficiency (OIAI) remains underappreciated. This review summarizes what is currently known regarding the prevalence, predictive factors for the development and effect of treatment of OIAI.
Although several case reports have highlighted the development of adrenal crisis among those receiving chronic opioids, only a few studies have systematically assessed patients for OIAI. The heterogeneity of these small studies presents challenges when trying to assess prevalence of or potential risk factors for OIAI. The estimated prevalence of OIAI among those treated with chronic opioids ranges from 8.3 to 29% and is more likely in those receiving higher doses of opioids. Reduced health-related quality of life variables and altered pain perception has been associated with lower cortisol levels; however, the effect of glucocorticoid replacement on the parameters remains unknown.
Further research is critical to better identify those at greatest risk and guide optimal management of OIAI. Frontline providers should remain vigilant for possibility of OIAI among chronic opioid users.
尽管阿片类药物滥用已被宣布为一种流行疾病，但阿片类药物的使用仍然普遍存在。慢性阿片类药物使用的副作用仍然是一个问题。阿片类药物引起的内分泌疾病已有充分的记载，但阿片类药物引起的肾上腺功能不全（OIAI）仍然被低估。这篇综述总结了目前已知的 OIAI 的流行率、发生发展的预测因素以及治疗效果。
尽管有几例报告强调了接受慢性阿片类药物治疗的患者中肾上腺危象的发展，但只有少数研究系统地评估了患者的 OIAI。这些小型研究的异质性在评估 OIAI 的患病率或潜在危险因素时带来了挑战。接受慢性阿片类药物治疗的患者中 OIAI 的估计患病率为 8.3%至 29%，且在接受更高剂量阿片类药物的患者中更常见。健康相关生活质量变量的降低和疼痛感知的改变与皮质醇水平降低有关；然而，皮质激素替代治疗对这些参数的影响仍不清楚。
进一步的研究对于更好地确定高危人群和指导 OIAI 的最佳管理至关重要。一线医务人员应密切关注慢性阿片类药物使用者中 OIAI 的可能性。
