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Bmj opioid induced hypogonadism treatment – Opioid induced hypogonadism

Home » Pain Treatments » Pharmacological » Opioids.

Lucas Cox
Thursday, August 16, 2018
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  • Assessment of gonadotropins and testosterone hormone levels in regular Mitragyna speciosa Korth. J Pharmacol Exp Ther ;

  • Fednekar J and Mulgacnker V. Testosterone reduces responsiveness to nociceptive stimuli in a wild bird.

  • BMJ Open.

  • In addition, hypocortisolism can manifest a wide variety of symptoms, such as fatigue, malaise, abdominal discomfort, anorexia, and orthostatic hypotension.

Publication types

Hypogonadism in both sexes is a common result of ongoing treatment with opioid analgesics and can be treated with suitable hormone replacement therapy. The aim of this systematic review and meta-analysis was to assess the effects of opioid use on pituitary function. Furthermore, we systematically reviewed the effects of opioids on the various hypothalamic—pituitary—end organ axes gonadal, adrenal, thyroid, somatotroph, and prolactin secretionas well as the effects of hormone replacement on opioid-related endocrine deficiencies.

In accord with our results, a study comparing long-term opioid users to age- and sex-matched controls found that The impact of opioids on the endocrine system. Case reports Case 1 A 42 year old man, followed up in our department for primary hyperparathyroidism, presented with episodes of flushing and sweating. A literature search was conducted to identify studies describing endocrine effects of opioid use. In contrast to our findings, two studies described higher ACTH concentrations, and hair cortisol in opioid-treated patients compared to controls 16 What are the adverse effects of prolonged opioid use in patients with chronic pain? Besides the inhibitory effect of opioids on the gonadal axis, our study showed that the likelihood of gonadotroph deficiency differed between the various opioids, and this was highest after fentanyl exposure.

Androgen deficiency in long-term intrathecal opioid administration. If people taking opioids present with depression, a diagnosis of remediable hypogonadism may be considered. Clin Endocrinol. A literature search was conducted to identify studies describing endocrine effects of opioid use.

Publication types

Recently, it has been reported that chronic use of opioids induces endocrine dysfunctions in humans [ 2 — 11 ]. Therefore, he is planned to have the hormone replacement therapy. Opioid-Induced Constipation: Treatment Modalities. Hypogonadism increases the sensitivity of pain, and sex hormone administration decreases its sensitivity in experimental animals [ 39 — 41 ].

Open in new tab. View Metrics. However, the results of our systematic review showed no difference in the effects of opioids on the endocrine system between different populations. If people taking opioids present with depression, a diagnosis of remediable hypogonadism may be considered.

  • Dysfunction of the hypothalamic-pituitary-adrenal axis in opioid dependent subjects: effects of acute and protracted abstinence.

  • Maeyaert et al. Carlucci et al.

  • Pain Medicine.

  • Therefore, his hypogonadism was diagnosed to be caused by opioid treatment. Carlucci et al.

  • Manipulation and Massage.

  • Exp Clin Endocrinol Diabetes ; Periodical evaluation of at least the gonadal and adrenal axes is therefore advisable.

Hypogonadism can lead to erectile dysfunction, impotence, a loss of muscle mass in men, and irregular periods or amenorrhoea in women. If people taking opioids present with depression, a diagnosis of remediable hypogonadism may be considered. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. Try out PMC Labs and tell us what you think. Changes in growth hormone and luteinizing hormone following acute or chronic administration of an opioid agonist, FK, in wethers. Endocrine consequences of long-term intrathecal administration of opioids. In total, 21 studies with patients described the effects of opioid use on the activity of the HPA axis

Am J Med. These ooioid resulted in prevalence in the upper range of what has been previously reported in reviews 29bmj opioid induced hypogonadism treatment and stress the importance of thorough endocrinological examination of opioid users. This provides a more accurate estimation of the percentage of opioid exposure-related hypogonadism and cortisol deficiency, compared to narrative reviews. Male patients can present with erectile dysfunction, impotence, and gynecomastia, while female patients can have menstrual irregularities. Data on the interaction between the different axes are lacking.

Discussion

Caterini, and H. Verhelst, J. Rheumatologic and Myofascial Pain. Reprod Biol and Endo.

Arch Public Health. Open in new tab. Oral opioids for chronic noncancer pain: higher prevalence of hypogonadism in men than in women. Provenance and peer review: Not commissioned; externally peer reviewed. Horm Metab Res. Funding: No additional funding.

Clin Pharmacol Ther ; 35 Effects of testosterone replacement in men hypogonadism treatment opioid-induced androgen deficiency: a randomized controlled trial. The increased use of opioids has resulted in an unprecedented opioid epidemic. The effects on the gonadal axis of each gender are reported separately. Funding: No additional funding. Drug-induced HPA axis alterations during acute critical illness: a multivariable association study. Sign In or Create an Account.

  • The studies in this sensitivity analyses have been mainly selected on the most reliable endocrine testing being used.

  • Another is that the anterior pituitary, which controls testosterone, along with growth hormone GHprolactin, thyroid stimulating hormone TSHadrenalcorticotrophic hormone, luteinizing hormone LHand follicle stimulating hormone, has an altered response to gonadrotropin-releasing hormone.

  • Provenance and peer review: Not commissioned; externally peer reviewed. J Sex Med ; 5

  • In the present case, because his chronic pain was severe and uncontrolled by regular analgesics, physical therapy, and buprenorphine, opioid treatment could not be reduced or stopped.

Types of Pain Acute Pain. Rheumatologic and Myofascial Pain. Furthermore, his hypogonadotropic symptom such as loss of libido and erectile dysfunction appeared after starting treatment with transdermal fentanyl. Therefore, his hypogonadism was diagnosed to be caused by opioid treatment. Accessed July 23,

Contributors: All authors contributed equally to writing and editing. United Nations Office on Drugs and Crime. On magnetic resonance imaging the pituitary was normal. N Engl J Med. Pooled percentage and sensitivity analysis, only including low risk of bias studies, of opioid exposure-related hypogonadism. In contrast to our findings, two studies described higher ACTH concentrations, and hair cortisol in opioid-treated patients compared to controls 16 Characteristics of the studies included in the meta-analyses.

Case Reports in Medicine

View at: Google Scholar C. Download other formats More. Fehm, and A.

  • Try out PMC Labs and tell us what you think.

  • Lichtermann, and D.

  • In man the mu-opiate agonist loperamide specifically inhibits ACTH secretion induced by the cholecystokinin-like peptide ceruletide.

Agho, C. These endocrine dysfunctions not only lead to impaired quality of life and metabolic abnormalities but sometimes induce lethal conditions such as adrenal crisis [ 10 ]. Walters, J. Dehydroepiandrosterone DHEA is a testosterone precursor that also may raise serum testosterone levels. Lightman, and D.

Accessed July bmj opioid induced hypogonadism treatment, A year-old male patient suffered from severe pain after opiooid brachial plexus injury by traffic accident since Furthermore, these adverse effects can be avoided by stopping or reducing opioid treatment or hormone replacement therapy. Opioids have also been reported to affect other endocrine functions. Taken together, we thought that his hypogonadotropic hypogonadism was most likely caused by chronic use of transdermal fentanyl.

Materials and Methods

Please review our privacy policy. The prevalence may be higher in men, and in those receiving a larger dose of opioids, especially via the intrathecal route. Clin Endocrinol Oxf. Patient consent obtained. Permissions Icon Permissions.

Cotricotropic axis. Nienke R Biermasz. Bruce CA. J Clin Endocrinol Metab. Lastly, opioids induce the conversion of testosterone to dihydrotestosterone 9. In case of no response, authors were approached a second time; however, ultimately no additional subject level data could be obtained.

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In case of no response, authors were approached a second time; however, ultimately no additional subject level data could be obtained. Opioid-induced adrenal insufficiency. Chronic pain therapy and hypothalamic—pituitary—adrenal axis impairment. No clear effects on the somatotropic and hypothalamo—pituitary—thyroid axes were described. Opioids any drug which binds to the opioid receptors in the central nervous system, of which natural opiates are a subclass are now increasingly prescribed worldwide in every age group, for acute and chronic, cancerous and non-cancerous, pain. Seven studies, including patients, described the results of the effects of opioids on the HPT axis For those who cannot avoid opioids, hormone replacement therapy testosterone in men, and oestrogen with or without progesterone in women should be offered as appropriate, to relieve symptoms and prevent the long term consequences box.

Dr Treatmenh Welliver would like to gratefully acknowledge Matthew Aoun for his help with updating this topic. Volume 21, Issue 4. The response to analgesia testing is affected by gonadal steroids in the rat. Opioids have been widely used for the management of acute, chronic, malignant, and nonmalignant pain in the world [ 1 ].

The effect of opioid therapy on endocrine function. The aim of testosterone therapy is to achieve bmj opioid induced hypogonadism treatment testosterone levels within the normal physiological range with dose adjustment to have the maximum effect on alleviation of symptoms. Key diagnostic factors decreased libido loss of spontaneous morning erections erectile dysfunction gynaecomastia infertility galactorrhoea micro-penis small testes bifid scrotum cryptorchidism eunuchoid proportions bitemporal hemianopia low trauma fractures loss of height anosmia More key diagnostic factors.

Home » Pain Treatments » Pharmacological » Opioids. View at: Google Scholar J. Task Force, Endocrine Society. Role of testosterone on pain threshold in rats. Last reviewed: 2 Jul Neuropathic Pain. Taylor, R.

Lightman, and D. View at: Google Scholar A. Am J Med. Lentz, hypogoandism N. Human chorionic gonadotropin HCG carries a label of treating hypogonadism, and it may be a substitute or adjunctive treatment for low testosterone, particularly in females. Sexual difficulties of chronic pain patients. The present case has no abnormal adrenal, GH, and thyroid functions.

Adequate endocrine testing was considered the most important element of the final risk of bias classification. Pain Med. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. Related articles in Web of Science Google Scholar.

Grossman, and G. More related articles. Interestingly, several studies have shown the association of hypogonadism with pain. On the other hand, it has been reported in a small number of cases that adrenal insufficiency and adult growth hormone deficiency can also occur [ 21011 ]. Risk factors genetic anomaly type 2 diabetes mellitus use of alkylating agents, opioids, or glucocorticoids use of exogenous sex hormones and GnRH analogues hyperprolactinaemia pituitary tumour or apoplexy critical illness testicular damage varicocele auto-immune testicular damage More risk factors.

Oxford Academic. Sensitivity analysis for the gonadal axes was performed by analyses of studies with a low risk of bias. PLoS One. Int J Androl. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. Opioid endocrinopathy: a clinical problem in patients with cancer pain.

Bell, W. Knaus-Dittmann, H. Lentz, and N.

Hallinan, A. Gilson, K. Female pain patients with low testosterone levels may also require testosterone replacement. View at: Google Scholar B.

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Twenty authors of studies reporting on the induced hypogonadism treatment of the hypothalamo— pituitary—gonadal and hypothalamus—pituitary—adrenal HPA axis were contacted and asked to provide additional data on the prevalence of these respective deficiencies. Pain Res Manag. In addition, several studies suggest that the endocrine system is affected in opioid users 78. Pooled percentage and sensitivity analysis, only including studies using ITT as assessment of the HPA axis, of opioid exposure-related hypocortisolism. Patient consent obtained. London: Home Office,

Administrative, technical, or material support: JWS. Regarding induced hypogonadism treatment somatotropic axis, animal studies showed stimulated GH secretion after short-term administration of opioids Besides the inhibitory effect of opioids on the gonadal axis, our study showed that the likelihood of gonadotroph deficiency differed between the various opioids, and this was highest after fentanyl exposure. Prescriptions dispensed in the community, statistics for to England. Accepted Jul 7.

However, opioids have several adverse effects such as itching, nausea, constipation, and respiratory suppression. Opioid-Induced Constipation: Treatment Modalities. Another is that the anterior pituitary, which controls testosterone, along with growth hormone GHprolactin, thyroid stimulating hormone TSHadrenalcorticotrophic hormone, luteinizing hormone LHand follicle stimulating hormone, has an altered response to gonadrotropin-releasing hormone. Adams, B. De Padova, and C.

Case reports

Morley-Forster et al. Veldhuis, and J. Ellingboe, J.

View at: Google Scholar F. Case Report A year-old male patient suffered from severe pain after left brachial plexus injury by traffic accident since Task Force, Endocrine Society. Pullan, C. Received 17 Oct Katz and N.

  • Donegan DBancos I. Oxford: Oxford University Press,

  • Human chorionic gonadotropin HCG carries a label of treating hypogonadism, and it may be a substitute treatmenf adjunctive treatment for low testosterone, particularly in females. Opioids have been shown to decrease the release of gonadotropin-releasing hormone GnRH and disrupt its normal pulsatility in the hypothalamus, resulting in a reduction of the release of LH and FSH from the pituitary gland and that of testosterone and estradiol from the gonads [ 31423 — 29 ].

  • Pain Res Manag. Bruce CA.

  • As prolactin inhibits GnRH release from the hypothalamus, this is an additional mechanism of the hypogonadism observed in patients on opioids 9. Gonadal axis.

Vagenakis, and C. Fraser, D. Serum testosterone levels were unchanged. Opioid-Induced Constipation: Treatment Modalities. Walters, J.

Treatemnt Clin Endocrinol Metab ; 85 Furthermore, the heterogeneity between studies may have affected the robustness of our results. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. Placental miRp is associated with maternal insulin resistance in late pregnancy. Citing articles via Web of Science 7. Nienke R Biermasz. Skip Nav Destination Article Navigation.

Furthermore, hupogonadism systematically reviewed the effects of opioids on the various hypothalamic—pituitary—end organ axes gonadal, adrenal, thyroid, somatotroph, and prolactin secretionas well as the effects of hormone replacement on opioid-related endocrine deficiencies. The patient recovered with supplementation of corticosteroids. Drug and Alcohol Depend. Abs et al. Alberto M Pereira.

Neuropathic Pain. Almeida, K. These endocrine dysfunctions not only lead to impaired quality of life and metabolic abnormalities but sometimes induce lethal conditions such as adrenal crisis [ 10 ]. Mendelson, and V. Transdermal fentanyl used in the present case became possible to be prescribed under health insurance for patients with nonmalignant chronic pain from in Japan.

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Bmj opioid induced hypogonadism treatment Pharmacol Ther ; 35 Our results are in line with other smaller reviews, reporting on the effects of opioids on the endocrine system 42— Receive exclusive offers and updates from Oxford Academic. Am J Med. This may be of interest as the gonadal axis is impaired and prolactin levels are raised in opioid users. Dysfunction of both axes may result in significant, often incapacitating symptoms 2.

Rhodin, M. J Urol. Some studies evaluating the effect of opioid on the endocrine system in indhced have shown that they have high serum prolactin levels leading to inhibit the secretion of GnRH [ 93334 ]. The effect of opioid therapy on endocrine function. Volume 21, Issue 3.

Breivik, B. View at: Google Scholar B. Use of this content is subject to our disclaimer. Academic Editor: Gerald S. Brennan MJ.

Bhagat, and L. Stridsberg, and T. Interestingly, one patient has been reported to develop an adrenal crisis [ 10 ]. Radiography of the thorax, as well as an electrocardiogram, was normal.

Interventional Pain Management. However, because his treattment pain was severe and uncontrolled by regular analgesics such as nonsteroidal anti-inflammatory drugs, anticonvulsants, and buprenorphine, his transdermal fentanyl treatment could not be reduced or stopped. View at: Google Scholar M. The first option is to reduce or stop opioids and to switch to the treatment such as nonopioid pharmacologic agents, physical therapy, and transcutaneous electrical nerve stimulation. Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors.

Testosterone deficiency in non-cancer opioid-treated patients. The odds for androgen oploid were higher on high dose methadone OR 1. The public and the opioid-abuse epidemic. Another study reported that lower androgen levels were correlated to depressive symptoms in women on intrathecal opioids Oxford University Press is a department of the University of Oxford.

  • Furthermore, we systematically reviewed the effects of opioids on the various hypothalamic—pituitary—end organ axes gonadal, adrenal, thyroid, somatotroph, and prolactin secretionas well as the effects of hormone replacement on opioid-related endocrine deficiencies. The public and the opioid-abuse epidemic.

  • However, most of the opioid treatment has no effect on serum prolactin levels as shown in the present case [ 2333536 ]. J Clin Endocrinol Metab.

  • Effects of testosterone replacement in men with opioid-induced androgen deficiency: a randomized controlled trial.

  • However, long-term opioid treatment including transdermal fentanyl has several side effects such as fatigue, nausea, constipation, emotional disturbances, and respiratory suppression. In addition, recent studies have shown that patients with oral, intrathecal, or transdermal opioid treatment for chronic pain have hypogonadism [ 2 — 9 ].

  • Dysfunction of both axes may result in significant, often incapacitating symptoms 2. Donegan DBancos I.

  • Lentz, and N.

Letters to the Editor. Types of Pain. Samojlik, and N. Female pain patients with low testosterone levels may also require testosterone replacement. Maeyaert et al.

Oral and Maxillofacial Pain. Polakoski, and E. McKenzie C. However, because his chronic pain was severe and uncontrolled by regular analgesics such as nonsteroidal anti-inflammatory drugs, anticonvulsants, and buprenorphine, his transdermal fentanyl treatment could not be reduced or stopped. Fraser, D. Orstead and H.

Hypogonadism in men consuming sustained-action oral opioids. All analyses were performed using Stata 14 Stata Corp. In both these cases, hypogonadotrophic hypogonadism was most likely to have been caused by the chronic use of opioids. The effect of opioid therapy on endocrine function. Niki Karavitaki.

Patient consent obtained. Male patients can present with erectile dysfunction, impotence, and gynecomastia, while female patients opiooid have menstrual irregularities. It is plausible to assume that opioid exposure-related hypogonadism may also be present in women, as opioids suppress gonadal hormone secretion in both animals and humans via a central mechanism J Pharmacol Exp Ther ;

It is plausible to assume that opioid exposure-related hypogonadism may also be present in women, as opioids suppress gonadal hormone secretion in both animals and humans via a central mechanism The inhibitory effect of opioids on the gonadal and HPA axes is reported to be reversible when the opioid dose is tapered or when opioid therapy is abrogated 2. NHS Information Centre. J Clin Endocrinol Metab ; 90

Other Types of Pain. Samojlik, and N. A Day of Consulting in Rural America. Dluhy, and G.

J Pain ; 7 Exp Ther Med. Monitoring of bone density should also be considered.

  • Pain Med.

  • Cancer Pain. Opioids have been widely used for the management of acute, chronic, malignant, and nonmalignant pain in the world [ 1 ].

  • Am J Mens Health. As nearly all studies on opioid exposure-related hypogonadism included male patients, a definitive conclusion on the prevalence of opioid exposure-related hypogonadism among female patients cannot be drawn.

  • Abstract We report a case of year-old male patient with hypogonadotropic hypogonadism.

  • Consequently, testosterone serum testing and replacement when a deficiency is found is emerging as a routine measure for many pain specialists treating opioid- maintained pain patients. Case Report A year-old male patient suffered from severe pain after left brachial plexus injury by traffic accident since

  • Use of this content is subject to our disclaimer. Types of Pain Acute Pain.

Edgerton LLoven B. Prescriptions dispensed in the community, statistics for to England. If discussion failed to lead to a consensus, a third reviewer was consulted AHZN to reach consensus. Abstract Context. Monitoring of bone density should also be considered. Permissions Icon Permissions. He had received codeine phosphate and tramadol for over 10 years for pain relief.

Daniell, R. Pain Med. Two other reported studies show the benefits of testosterone replacement in opioid-induced hypogonadism. Gilson, K.

In addition, in morphine-induced hypogonadic male patients with chronic pain, jypogonadism replacement therapy progressively improves pain assessed by a validated Italian pain questionnaire [ 8 ]. A physical examination demonstrated no significant findings including loss of hircus and pubic hair. The Endocrine Society recommends that hypogonadal males be treated with testosterone to improve sexual drive and performance, increase bone mineral density, increase muscle mass, and decrease fat mass.

As his back pain was uncontrolled by regular analgesics opuoid tramadol and codeine, he was started on morphine sulphate by his general practitioner, titrating the doses of morphine sulphate to mg per day about six months before this presentation. His drugs also included aspirin, propranolol, omeprazole, fluoxetine, and loperamide. This heterogeneity is most prominent in the type of opioid used and the included study population between studies. However, amongst chronic opioid users no difference has been found in TSH or fT4 levels compared to controls 2. Materials and Methods.

  • Hyperprolactinaemia also, through opioids, tonically inhibits the secretion of gonadotrophin releasing hormone. In contrast to our findings, two studies described higher ACTH concentrations, and hair cortisol in opioid-treated patients compared to controls 16 ,

  • Ellingboe, J. Kennedy, R.

  • Hypogonadism in both sexes is a common result of ongoing treatment with opioid analgesics and can be treated with suitable hormone replacement therapy. Please review our privacy policy.

  • E-mail: amir lumc.

View at: Google Scholar H. Ventafridda, R. View at: Google Scholar A. Knaus-Dittmann, H. Clin J Pain. Mendelson, and V. We report a case of year-old male patient with hypogonadotropic hypogonadism.

Oral opioids for chronic noncancer pain: higher prevalence of hypogonadism tgeatment men than in women. The increased use of opioids has resulted in an unprecedented opioid epidemic. In contrast to our findings, two studies described higher ACTH concentrations, and hair cortisol in opioid-treated patients compared to controls 16 Google Scholar PubMed.

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