Opioid-induced Endocrinopathies - A Narrative Review

Objective To appraise available evidence on the impact of long-term opioid therapy on hormonal function in humans and outline an evidence-based approach to diagnosis and management. Method This is a narrative and scoping review. PubMed and Google Scholar were searched using key phrases. 87 articles including observational studies, review articles and relevant basic science articles were selected. Further articles were reviewed using reference lists of these 87 articles. Articles including critically ill patients were excluded. Research of studies was iterative and recursive. Relevant data on presentation and management of endocrine effects of chronic opioid therapy was extracted through content analysis. A narrative synthesis was performed for evidence for impact on each endocrine axis. Results Therapeutic opioid use leads to significant impact on multiple endocrine pathways. Clinically relevant impairment of hypothalamic-pituitary-gonadal (HPG), hypothalamic-pituitary-adrenal (HPA) axes, bone health, prolactin levels, glycemia and metabolism occurs. Most endocrine adverse effects are reversible on dose reduction or discontinuation. Recognition is therefore crucial. Conclusion Opioid-induced endocrinopathies are associated with increased morbidity and mortality. This risk should be discussed with patients before initiation of therapy, monitored during follow up and consideration given to tapering off or reducing opioids wherever possible.