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

Abstract

INTRODUCTION

Opioid therapy for pain relief is associated with several adverse effects. Herein, we report the potential consequences of opioid use on the adrenal function.

OBSERVATION

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.

CONCLUSION

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.

Authors+Show Affiliations

Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France. Electronic address: edouard.flamarion@aphp.fr.Service de médecine interne, hôpital Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.Service d'accueil des urgences et département d'aval des urgences, hôpital Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.

Pub Type(s)

English Abstract
Journal Article

Language

fre

PubMed ID

31444021

Citation

Flamarion, E, et al. "[Opioid-induced Adrenal Insufficiency: Case Report and Synthesis of the Literature]." La Revue De Medecine Interne, 2019.
Flamarion E, Saada N, Khellaf M, et al. [Opioid-induced adrenal insufficiency: Case report and synthesis of the literature]. Rev Med Interne. 2019.
Flamarion, E., Saada, N., Khellaf, M., Michon, A., Passeron, A., Pouchot, J., ... Ranque, B. (2019). [Opioid-induced adrenal insufficiency: Case report and synthesis of the literature]. La Revue De Medecine Interne, doi:10.1016/j.revmed.2019.07.003.
Flamarion E, et al. [Opioid-induced Adrenal Insufficiency: Case Report and Synthesis of the Literature]. Rev Med Interne. 2019 Aug 20; PubMed PMID: 31444021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Opioid-induced adrenal insufficiency: Case report and synthesis of the literature]. AU - Flamarion,E, AU - Saada,N, AU - Khellaf,M, AU - Michon,A, AU - Passeron,A, AU - Pouchot,J, AU - Arlet,J-B, AU - Ranque,B, Y1 - 2019/08/20/ PY - 2019/03/03/received PY - 2019/07/01/revised PY - 2019/07/17/accepted PY - 2019/8/25/entrez KW - Drug toxicity KW - Drépanocytose KW - Iatrogénie KW - Insuffisance surrénale secondaire KW - Opioids KW - Opioïdes KW - Secondary adrenal insufficiency KW - Sickle cell disease JF - La Revue de medecine interne JO - Rev Med Interne N2 - INTRODUCTION: Opioid therapy for pain relief is associated with several adverse effects. Herein, we report the potential consequences of opioid use on the adrenal function. OBSERVATION: 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. CONCLUSION: 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. SN - 1768-3122 UR - https://www.unboundmedicine.com/medline/citation/31444021/[Opioid-induced_adrenal_insufficiency:_Case_report_and_synthesis_of_the_literature] L2 - https://linkinghub.elsevier.com/retrieve/pii/S0248-8663(19)30604-6 DB - PRIME DP - Unbound Medicine ER -