Adrenal insufficiency in patients on long-term opioid analgesia.
OBJECTIVE
Opioid analgesia has been implicated as a cause of secondary adrenal insufficiency, but little is known of the prevalence of this potentially serious adverse effect in patients with chronic pain.


METHODS
Cross-sectional study of chronic pain patients on long-term opioid analgesia.


METHODS
Patients attending tertiary chronic pain clinics at the Western General Hospital, Edinburgh, treated with long-term opioid analgesia (n = 48) with no recent exposure to exogenous glucocorticoids.


RESULTS
Four patients (8·3%) had basal morning plasma cortisol concentrations below 100 nmol/l, of whom three failed to achieve a satisfactory cortisol response to exogenous ACTH1-24stimulation (peak cortisol >430 nmol/l). Basal cortisol was positively associated with age (R = 0·398, P = 0·005) and negatively associated with BMI (R = -0·435, P = 0·002).


CONCLUSIONS
Suppression of the hypothalamic-pituitary-adrenal axis is present in a clinically significant proportion of chronic pain patients treated with opioid analgesia. Studies of larger populations should be conducted to better define the prevalence and potential clinical consequences of adrenal insufficiency in this context.
Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian and University of Edinburgh, Edinburgh, UK.
Fraser W
FW
Gibb
Department of Anaesthetics, Royal Infirmary of Edinburgh, Edinburgh, UK.
Alexandra
A
Stewart
Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian and University of Edinburgh, Edinburgh, UK.
Brian R
BR
Walker
Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian and University of Edinburgh, Edinburgh, UK.
Mark W J
MW
Strachan
D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000367:Age Factors; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D059350:Chronic Pain / Q000150:complications* / Q000188:drug therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects
D000701:Analgesics, Opioid; D006854:Hydrocortisone