Chronic fentanyl application induces adrenocortical insufficiency.
We report a case of a 64-year-old man with secondary adrenocortical insufficiency who has been on a chronic transdermal fentanyl treatment because of sciatic pain syndrome. Shortly before admission to our hospital, the patient had discontinued his hydrocortisone medication. Adrenal crisis was assumed and during therapy with hydrocortisone infusion, the patient recovered. We suspected an opiate-induced suppression of the hypothalamus-pituitary-adrenal (HPA) axis. Therefore, we gradually reduced the opiate dosage. After 1 week, HPA axis function was markedly improved. We conclude that opiate medication may inhibit - in a life-threatening way - the organism's ability to respond to physical, emotional or metabolic stressors.
Oltmanns
K M
KM
Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany. oltmanns@medinf.mu-luebeck.de <oltmanns@medinf.mu-luebeck.de>
Fehm
H L
HL
Peters
A
A
D000279:Administration, Cutaneous; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000188:drug therapy; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology; D012585:Sciatica / Q000150:complications / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D009294:Narcotics; D005283:Fentanyl; D006854:Hydrocortisone