Ebersole Ashley M, McKnight Lucas, Vijayaraman Akshay, Guarneri Alissa, Bonny Andrea E
Adolescent Medicine, Nationwide Children's Hospital, Columbus, USA.
Internal Medicine: Pediatrics, The Ohio State University Wexner Medical Center and Nationwide Children's Hospital, Columbus, USA.
Cureus. 2023 Jul 12;15(7):e41794. doi: 10.7759/cureus.41794. eCollection 2023 Jul.
Opioid-induced adrenal insufficiency is a known side effect of chronic opioid use, but opioid-induced adrenal insufficiency related to chronic buprenorphine-naloxone therapy is less well-known. We present a case of a patient with opioid use disorder on chronic buprenorphine-naloxone therapy admitted with presumed septic shock and found to be in an adrenal crisis. The patient presented to our hospital with a shock-like presentation, requiring vasopressors, intubation, empiric glucocorticoids, and antibiotics. As her steroids were weaned, she developed bradycardia and blood glucose in the 60s. A low- and high-dose cosyntropin stimulation test confirmed the presence of secondary adrenal insufficiency, presumed to be due to her chronic buprenorphine-naloxone use. She was discharged on maintenance hydrocortisone and continued buprenorphine-naloxone therapy. With the high prevalence of opioid use disorder and the common need for medication for opioid use disorder, it is important that healthcare providers properly identify opioid-induced adrenal insufficiency in order to quickly and correctly diagnose and treat adrenal crises.
阿片类药物所致肾上腺功能不全是长期使用阿片类药物已知的副作用，但与长期丁丙诺啡 - 纳洛酮治疗相关的阿片类药物所致肾上腺功能不全却鲜为人知。我们报告一例患有阿片类药物使用障碍且正在接受长期丁丙诺啡 - 纳洛酮治疗的患者，该患者因疑似感染性休克入院，结果发现处于肾上腺危象状态。该患者以类似休克的症状就诊于我院，需要使用血管加压药、进行插管、给予经验性糖皮质激素和抗生素治疗。随着她的类固醇药物逐渐减量，她出现了心动过缓，血糖降至60多。一次低剂量和高剂量促肾上腺皮质激素刺激试验证实存在继发性肾上腺功能不全，推测是由于她长期使用丁丙诺啡 - 纳洛酮所致。她出院时继续服用维持剂量的氢化可的松，并继续接受丁丙诺啡 - 纳洛酮治疗。鉴于阿片类药物使用障碍的高患病率以及对阿片类药物使用障碍进行药物治疗的普遍需求，医疗保健提供者正确识别阿片类药物所致肾上腺功能不全以便快速、正确地诊断和治疗肾上腺危象非常重要。
