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© 2016 John Wiley & Sons Ltd Objective: Opioid analgesia has been implicated as a cause of secondary adrenal insufficiency, but little is known of the prevalence of this potentially serious adverse effect in patients with chronic pain. Design: Cross-sectional study of chronic pain patients on long-term opioid analgesia. Patients: Patients attending tertiary chronic pain clinics at the Western General Hospital, Edinburgh, treated with long-term opioid analgesia (n = 48) with no recent exposure to exogenous glucocorticoids. Results: Four patients (8·3%) had basal morning plasma cortisol concentrations below 100 nmol/l, of whom three failed to achieve a satisfactory cortisol response to exogenous ACTH1-24 stimulation (peak cortisol >430 nmol/l). Basal cortisol was positively associated with age (R = 0·398, P = 0·005) and negatively associated with BMI (R = −0·435, P = 0·002). Conclusions: Suppression of the hypothalamic−pituitary−adrenal axis is present in a clinically significant proportion of chronic pain patients treated with opioid analgesia. Studies of larger populations should be conducted to better define the prevalence and potential clinical consequences of adrenal insufficiency in this context.
Author(s): Gibb FW, Stewart A, Walker BR, Strachan MWJ
Publication type: Article
Publication status: Published
Journal: Clinical Endocrinology
Year: 2016
Volume: 85
Issue: 6
Pages: 831-835
Print publication date: 01/12/2016
Online publication date: 04/06/2016
Acceptance date: 01/06/2016
ISSN (print): 0300-0664
ISSN (electronic): 1365-2265
Publisher: Wiley-Blackwell
URL: https://doi.org/10.1111/cen.13125
DOI: 10.1111/cen.13125
PubMed id: 27260138
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