Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands.
J Clin Endocrinol Metab. 2020 Mar 1;105(3):1020-9. doi: 10.1210/clinem/dgz022.
The increased use of opioids has resulted in an unprecedented opioid epidemic. Chronic opioid use causes hypogonadism, but its frequency, as well as the effects of opioids on other hypothalamo-pituitary-end organ hormone axes, remains unclear.
The aim of this systematic review and meta-analysis was to assess the effects of opioid use on pituitary function.
Eight electronic databases were searched for articles published up to May 8, 2018. Fixed or random effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals (CI). This study is reported following the PRISMA and MOOSE guidelines.
52 studies (22 low risk of bias) were included describing 18 428 subjects, consisting of patients with chronic pain (n = 21 studies) or on maintenance treatment for opioid addiction (n = 9) and healthy volunteers (n = 4). The most frequently used opioid was methadone (n = 13 studies), followed by morphine (n = 12). Prevalence of hypogonadism was 63% (95% CI: 55%-70%, 15 studies, 3250 patients, 99.5% males). Prevalence of hypocortisolism relying on dynamic and nondynamic testing was 15% (95% CI: 6%-28%, 5 studies, 205 patients, 57.5% males) and including only studies using the insulin tolerance tests 24% (95% CI 16%-33%, 2 studies, n = 97 patients). In 5 out of 7 studies, hyperprolactinemia was present. No clear effects on the somatotropic and hypothalamo-pituitary-thyroid axes were described.
Hypogonadism occurs in more than half of male opioid users, and hypocortisolism in approximately one-fifth of all patients. Periodical evaluation of at least the gonadal and adrenal axes is therefore advisable.
阿片类药物使用的增加导致了前所未有的阿片类药物流行。慢性阿片类药物使用会导致性腺功能减退症，但它的发生频率以及阿片类药物对其他下丘脑-垂体-终器官激素轴的影响尚不清楚。
本系统评价和荟萃分析的目的是评估阿片类药物使用对垂体功能的影响。
检索截至 2018 年 5 月 8 日发表的文章，使用 8 个电子数据库。采用固定或随机效应荟萃分析估计合并的比例及其 95%置信区间（CI）。本研究按照 PRISMA 和 MOOSE 指南进行报告。
纳入了 52 项研究（22 项低偏倚风险），共描述了 18428 名受试者，包括慢性疼痛患者（21 项研究）或接受阿片类药物成瘾维持治疗的患者（9 项研究）和健康志愿者（4 项研究）。最常使用的阿片类药物是美沙酮（13 项研究），其次是吗啡（12 项研究）。性腺功能减退症的患病率为 63%（95%CI：55%-70%，15 项研究，3250 例患者，99.5%为男性）。依赖于动态和非动态测试的皮质醇功能减退症的患病率为 15%（95%CI：6%-28%，5 项研究，205 例患者，57.5%为男性），包括仅使用胰岛素耐量试验的研究则为 24%（95%CI：16%-33%，2 项研究，97 例患者）。在 7 项研究中有 5 项存在高泌乳素血症。对生长激素和下丘脑-垂体-甲状腺轴没有明显的影响。
超过一半的男性阿片类药物使用者出现性腺功能减退症，约五分之一的患者出现皮质醇功能减退症。因此，建议定期评估至少性腺和肾上腺轴的功能。
Zotero 插件
