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02/06/2009 - Opioid-Induced Endocrine Disorders
The most prevalent class of drug presenting to the Center for Addiction Medicine for detoxification and treatment are the opioid drugs – Prescription hydrocodone/oxycodone, heroin, morphine, and methadone. The withdrawal syndrome is relatively indistinguishable for all drugs within this class.
Frequently overlooked are signs and symptoms of endocrine complaints associated with long-term usage of these drugs. These patient complaints include depression, fatigue, weight gain, menstrual irregularities, decreased muscle mass, decreased libido, and sexual dysfunction. In men and women, a significant proportion are testosterone and estradiol deficient because of decreased production of adrenal androgens. It is much more difficult to make a clinical diagnosis in women because of the difficulty in measuring low testosterone levels and because normal ranges are not well established. In men, serum testosterone normal ranges are well known, however there is no absolute threshold below which symptoms of androgen deficiency may occur. The inadequate production of sex hormones is referred to as hypogonadism.
In a recent article in the Journal of the American Osteopathic Association, the authors state that chronic nonmalignant pain treatment has resulted in a 127% increase in prescription opioid medications from 1997 to 2006. As expected, abuse of this class of drug has also exponentially increased and now ranks as one of the most abused classes of drug in the world.
Treatment for these problems may consist of testosterone supplementation or use of DHEA which is available as a dietary supplement. These treatments should only be utilized after appropriate laboratory testing and under the direction of a physician trained in use of these pharmacologies. In men, amounts higher than needed may increase the risk of prostatic hypertrophy and prostate cancer. It is unfortunate that little guidance for treatment of women is noted in the clinical literature.
Addiction medicine and pain management specialists have observed these adverse effects from opioid abuse and dependence for many years. It is important to address these issues in clinical practice and to offer the patient hope that the condition is treatable.