Patients taking opioids for chronic pain are at risk of hormone deficiencies. Male hypogonadism is a recognized adverse effect of opioid use, and higher rates of adrenal insufficiency have recently been reported.
To compare pituitary function, rates of deficiency of pituitary hormones, sexual function and quality of life in patients on oral or transdermal opioids compared to age and sex-matched controls.
Opioid therapy is commonly used for severe chronic pain. Adrenal insufficiency and hypogonadism impair health and quality of life, therefore prevalence data are required to determine potential risk of hormone deficiency among opioid users.
Participants with chronic non-malignant pain receiving oral or transdermal opioids for more than six months and matched controls provided morning (before 0900h) blood samples and completed validated questionnaires for general health, sexual function, fatigue and quality of life. Participants with morning serum cortisol levels <250 nmol/L underwent 250 mg short Synacthen test (SST) and overnight metyrapone test (OMT).
Forty patients treated with opioids (M:25, F:15) and 25 age matched controls (M:14, F:11) were studied. There was no difference in mean morning cortisol in the overall group or testosterone among the men, between opioid users and controls. However opioid users had a significantly higher rate of adrenal insufficiency defined by morning cortisol <250 nmol/L AND failing either the SST or OMT 9/40 vs 0/25 P=0.01. Serum DHEA-sulfate was also significantly lower in the opioid group versus controls (P<0.01).The proportion of male patients with serum testosterone <8 nmol/L was not significantly different between opioid users (11/24) and controls (2/14) P=0.08. Opioid treated patients scored significantly lower on all questionnaires.
A significant proportion of oral/transdermal opioid users are at risk of adrenal insufficiency. Further data are required to determine screening and management strategies, including opioid reduction, opioid rotation, or hormone replacement.