Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy.
Unit of Anaesthesia, Intensive Care, and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy.
Int J Mol Sci. 2023 Feb 26;24(5):4575. doi: 10.3390/ijms24054575.
Among several opioid-associated endocrinopathies, opioid-associated adrenal insufficiency (OIAI) is both common and not well understood by most clinicians, particularly those outside of endocrine specialization. OIAI is secondary to long-term opioid use and differs from primary adrenal insufficiency. Beyond chronic opioid use, risk factors for OIAI are not well known. OIAI can be diagnosed by a variety of tests, such as the morning cortisol test, but cutoff values are not well established and it is estimated that only about 10% of patients with OIAI will ever be properly diagnosed. This may be dangerous, as OIAI can lead to a potentially life-threatening adrenal crisis. OIAI can be treated and for patients who must continue opioid therapy, it can be clinically managed. OIAI resolves with opioid cessation. Better guidance for diagnosis and treatment is urgently needed, particularly in light of the fact that 5% of the United States population has a prescription for chronic opioid therapy.
在几种阿片类药物相关的内分泌疾病中，阿片类药物相关肾上腺功能不全（OIAI）较为常见，但大多数临床医生，尤其是非内分泌专科的医生对其认识不足。OIAI 是长期使用阿片类药物引起的，与原发性肾上腺功能不全不同。除了慢性阿片类药物使用外，OIAI 的危险因素尚不清楚。OIAI 可以通过多种检查来诊断，如晨皮质醇试验，但尚未确定明确的截断值，据估计，只有约 10%的 OIAI 患者会得到正确诊断。这可能是危险的，因为 OIAI 可导致潜在的危及生命的肾上腺危象。OIAI 可以治疗，对于必须继续接受阿片类药物治疗的患者，可以进行临床管理。OIAI 会随着阿片类药物的停用而缓解。迫切需要更好的诊断和治疗指南，特别是考虑到美国 5%的人口有慢性阿片类药物治疗的处方。
