Opioid-induced adrenal insufficiency: Case report and synthesis of the literature

Opioid therapy for pain relief is associated with several adverse effects. Herein, we report the potential consequences of opioid use on the adrenal function. A 49-year-old woman with sickle cell anemia (Hemoglobin SS) was admitted for the treatment of a vaso-occlusive crisis. Morphine was used for...

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Bibliographic Details
Published in:La revue de medecine interne 2019-11, Vol.40 (11), p.758-763
Main Authors: Flamarion, E, Saada, N, Khellaf, M, Michon, A, Passeron, A, Pouchot, J, Arlet, J-B, Ranque, B
Format: Article
Language:fre
Subjects:
Adrenal Insufficiency - chemically induced
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - adverse effects
Anemia, Sickle Cell - drug therapy
Animals
Female
Humans
Middle Aged
Morphine - administration & dosage
Morphine - adverse effects
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Summary:Opioid therapy for pain relief is associated with several adverse effects. Herein, we report the potential consequences of opioid use on the adrenal function. A 49-year-old woman with sickle cell anemia (Hemoglobin SS) was admitted for the treatment of a vaso-occlusive crisis. Morphine was used for pain management, provided by intravenous intermittent dosing (patient-controlled analgesia). She developed during the hospitalization low blood pressure, due to secondary adrenal insufficiency (cortisol 74 nmol/L; ACTH 2.9pmol/L). Pituitary gland was normal on brain magnetic resonance imaging and adrenal function recovered after morphine discontinuation. Opioids suppress cortisol secretion, primarily mediated by direct negative effect on hypothalamus and pituitary gland. Further studies are needed to define the incidence and the clinical significance of opioid-induced adrenal insufficiency, as well as the need for hormone replacement.
ISSN:1768-3122
DOI:10.1016/j.revmed.2019.07.003