Presented at the 2012 AAPM Annual Meeting « Back

Endocrine Abnormalities After 20 Years of Opioid Therapy

Forest S. Tennant, MD DrPH, veractinc@msn.com, Veract Intractable Pain Clinic, West Covina, California

Introduction/Statement of the Problem: Little is known about opioid affects on the pituitary-adrenal-gonadal axis after a long period of treatment.1,2 Materials and Methods: Eighteen (18) intractable, pain patients in a rural California county clinic were maintained on opioids under the auspices of the California Intractable Pain Act for 20 or more years. Ten (10) male and eight (8) female adults used over 300mg equivalent of morphine daily. No hormone replacement was prescribed by the pain treatment clinic. Each patient had an 8:00AM, fasting serum specimen taken and tested for: cortisol, pregnenolone, testosterone, estrogen, corticotropin (ACTH), and follicle stimulating hormone (FSH). Results: One (5.6%) patient was normal on all six assays. The most common abnormality was low FSH in 6 (33.3%) and low testosterone in 8 (44.4%). One (5.6%) patient each had low pregnenolone and estrogen levels, and 2 (11.9%) had low cortisol levels. High serum levels were found in patients as follows: pregnenolone (1,5.6%), ACTH (4,22.2%), estrogen (1,5.6%), and cortisol (4,22.2%). Conclusions: The major effect of opioids FSH and testosterone. The high levels of ACTH, estrogen, pregnenolone, and cortisol in some patients indicates that severe pain and its endocrine response may not be controlled by high dose opioids.3 Patients with intractable pain must be routinely monitored with pituitary-adrenal-gonadal axis screening and clinically treated for deficient or excessive hormone levels. References: 1)Pfeiffer A, Herz A. Endocrine actions of opioids. Horm Metab Res 1984;16:386-397. 2)Elliott JA, Horton E, Fibuch EE. The endocrine effects of long-term oral opioid therapy: a case report and review of the literature. J Opioid Manag 2011;7:145-154. 3)Tennant F, Hermann L. Normalization of serum cortisol concentration with opioid treatment of severe chronic pain. Pain Med 2002;3:132-134.

Funding: None