title: Opioid Related Endocrinopathy.
abstract: OBJECTIVE
  Millions of patients continue to require opioid analgesics for control of moderate to severe chronic pain, which is a disease that affects more Americans than cancer, heart disease, and diabetes combined. Common opioid adverse effects include constipation, sedation, and nausea. A lesser-known sequelae is opioid induced androgen deficiency (OPIAD). The objective of this review was to better characterize the effects of opioids on the endocrine system.
  
  
  METHODS
  Published data were evaluated to identify links between opioid use and hypogonadism, as well as to describe proposed physiological mechanisms.
  
  
  RESULTS
  Chronic opioid use may predispose to hypogonadism through alteration of the hypothalamic-pituitary-gonadal axis as well as the hypothalamic-pituitary-adrenal-axis. The resulting hypogonadism and hypotestosteronism may contribute to impaired sexual function, decreased libido, infertility, and osteoporosis- none of which may be clinically recognized as opioid related.
  
  
  CONCLUSIONS
  OPIAD is a recognized consequence of long-term opioid therapy. Patients initiated or maintained on opioids should be queried about symptoms that might suggest hypogonadism including irregular menses, reduced libido, depression, fatigue, and hot flashes or night sweats. Some clinicians recommend assessment of baseline testosterone levels prior to initiating therapy. Additional data appear necessary to formulate guidelines regarding the diagnosis and management of OPIAD. Options include, rotating, reducing the dose or type, or cessation of opioid therapy or adding hormonal supplementation in the form of androgen replacement therapy. There are multiple formulations of testosterone available for replacement therapy, which is usually guided by laboratory measurements.
authors.affiliation: Department of Pain Management and Palliative Care, Englewood Hospital and Medical Center, Englewood, New Jersy, USA.|Anesthesiology, Icahn School of Medicine at Mt. Sinai, New York, New York, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gudin
authors.affiliation: Department of Pain Management and Palliative Care, Englewood Hospital and Medical Center, Englewood, New Jersy, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Laitman
authors.affiliation: International Clinical Research Institute, Overland Park, Kansas, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Nalamachu
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy; D004700:Endocrine System Diseases / Q000188:drug therapy*; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D010913:Pituitary-Adrenal System / Q000187:drug effects*
chemical_list: D000701:Analgesics, Opioid
keywords: Androgen Deficiency; Chronic Pain; Endocrinopathy; OPIAD; Opioid therapy; Testosterone