Healthcare providers are increasingly looking for signs of opioid-induced adrenal insufficiency (OIAI) in their patients, according to a presentation made at the American Association of Clinical Endocrinologists (AACE) Annual Scientific and Clinical Congress held in Los Angeles last week.
Chronic opioid use affects cortisol secretion, which is most likely due to how it interacts with the hypothalamus-pituitary-adrenal (HPA) axis. Physicians should be prepared to look for the signs and symptoms of this condition―especially now in the midst of an opioid epidemic.
The study, which was led by Kwan Christina, M.D., a fellow with California Pacific Medical Center, featured a case study of a 54-year old woman with history of opioid abuse. She presented with generalized weakness, anorexia and depression. Lab results shows a corrected calcium of 13.7 mg/dL; non-parathyroid hormone (PTH) mediated hypercalcemia with PTH 17 pg/ml in setting of non-elevated PTH related peptide (PTHrp); low 25-hydroxyvitamin D; low 1,25 dihydroxyvitamin D; low vitamin A; hypoglycemia (glucose 13 mg/dL) and hypotension.
The patient had morning cortisol and ACTH levels that suggested a secondary adrenal insufficiency.
“Based on history and work-up, it was determined chronic opioid abuse was the most likely cause of her secondary adrenal insufficiency. The patient was started on steroids with immediate improvement. This case highlights two points: adrenal insufficiency should be considered as a cause of unexplained non-PTH mediated hypercalcemia and the significant impact of chronic opioid use on the HPA axis. Given the current opioid epidemic, physicians need to recognize this commonly overlooked clinical entity,” the authors wrote.