Adrenal Crisis Masked as Septic Shock in a Patient With Opioid Use Disorder on Buprenorphine

Opioid-induced adrenal insufficiency is a known side effect of chronic opioid use, but opioid-induced adrenal insufficiency related to chronic buprenorphine-naloxone therapy is less well-known. We present a case of a patient with opioid use disorder on chronic buprenorphine-naloxone therapy admitted...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-07, Vol.15 (7), p.e41794
Main Authors: Ebersole, Ashley M, McKnight, Lucas, Vijayaraman, Akshay, Guarneri, Alissa, Bonny, Andrea E
Format: Article
Language:English
Subjects:
Abdomen
Antibodies
Antigens
Blood clots
Cardiac arrhythmia
Case reports
Creatinine
Drug dosages
Edema
Fever
Glucose
Hepatitis C
Hormones
Internal Medicine
Medical imaging
Narcotics
Pediatrics
Pelvis
Pleural effusion
Proteins
Sepsis
Steroids
Substance Use and Addiction
Substance use disorder
Teenagers
Ultrasonic imaging
Urine
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Summary:Opioid-induced adrenal insufficiency is a known side effect of chronic opioid use, but opioid-induced adrenal insufficiency related to chronic buprenorphine-naloxone therapy is less well-known. We present a case of a patient with opioid use disorder on chronic buprenorphine-naloxone therapy admitted with presumed septic shock and found to be in an adrenal crisis. The patient presented to our hospital with a shock-like presentation, requiring vasopressors, intubation, empiric glucocorticoids, and antibiotics. As her steroids were weaned, she developed bradycardia and blood glucose in the 60s. A low- and high-dose cosyntropin stimulation test confirmed the presence of secondary adrenal insufficiency, presumed to be due to her chronic buprenorphine-naloxone use. She was discharged on maintenance hydrocortisone and continued buprenorphine-naloxone therapy. With the high prevalence of opioid use disorder and the common need for medication for opioid use disorder, it is important that healthcare providers properly identify opioid-induced adrenal insufficiency in order to quickly and correctly diagnose and treat adrenal crises.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.41794