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Opioid induced adrenal insufficiency

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Donegan, Diane

Current Opinion in Endocrinology, Diabetes and Obesity: June 2019 - Volume 26 - Issue 3 - p 133–138
doi: 10.1097/MED.0000000000000474

Purpose of review Despite the declaration of an opioid epidemic, opioid use remains prevalent. Side-effects of chronic opioid use continue to be problematic. Opioid-induced endocrinopathies have been well documented, yet opioid-induced adrenal insufficiency (OIAI) remains underappreciated. This review summarizes what is currently known regarding the prevalence, predictive factors for the development and effect of treatment of OIAI.

Recent findings Although several case reports have highlighted the development of adrenal crisis among those receiving chronic opioids, only a few studies have systematically assessed patients for OIAI. The heterogeneity of these small studies presents challenges when trying to assess prevalence of or potential risk factors for OIAI. The estimated prevalence of OIAI among those treated with chronic opioids ranges from 8.3 to 29% and is more likely in those receiving higher doses of opioids. Reduced health-related quality of life variables and altered pain perception has been associated with lower cortisol levels; however, the effect of glucocorticoid replacement on the parameters remains unknown.

Summary Further research is critical to better identify those at greatest risk and guide optimal management of OIAI. Frontline providers should remain vigilant for possibility of OIAI among chronic opioid users.

Department of Endocrinology and Diabetes, Indiana University School of Medicine, Indiana, USA

Correspondence to Diane Donegan, MB, BCh, BAO, Department of Endocrinology and Diabetes, Indiana University School of Medicine, IN 46202, USA. Tel: +1 317 274 1339/278 5090; fax: +1 317 278 0658; e-mail:

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