ArticleThe Journal of clinical endocrinology and metabolism2020
Prevalence of Opioid-Induced Adrenal Insufficiency in Patients Taking Chronic Opioids.
Article in The Journal of clinical endocrinology and metabolism, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 47 citations in OpenAlex.
- Dehydroepiandrosterone sulfate levels predict weight gain in women with anorexia nervosa.The International journal of eating disorders · 2022Trial
- Exploring hormonal influences on nicotine craving and use across the perinatal period: A prospective longitudinal study.Drug and alcohol dependence reports · 2026Article
- Long-term administration of hydrocortisone: down-regulating the level of cytokine and resulting in injuring testicular tissue of juvenile mice.BMC pharmacology & toxicology · 2025Article
- Dehydroepiandrosterone Sulfate in Diagnosing Mild Autonomous Cortisol Secretion and Adrenal Insufficiency.Journal of the Endocrine Society · 2025Review
- Met-enkephalin modulates the stress responses of plasma concentrations of corticosterone, delta opioid receptor binding, pro-enkephalin expression, and processing in chickens.Frontiers in physiology · 2025Article
- Transdermal Fentanyl Patch Effectiveness in Postoperative PainManagement in Orthopedic Patients: Literature Review.Journal of clinical medicine · 2024Review
- Iatrogenic adrenal insufficiency in adults.Nature reviews. Endocrinology · 2024Review
- Fertility and pregnancy in adrenal insufficiency.Endocrine connections · 2024Review
- Article
- Multivariable Model to Predict an ACTH Stimulation Test to Diagnose Adrenal Insufficiency Using Previous Test Results.Journal of the Endocrine Society · 2023Article
- Metabolic profiles associated with opioid use and opioid use disorder: a narrative review of the literature.Current addiction reports · 2023Article
- Article
- Adrenal Crisis Masked as Septic Shock in a Patient With Opioid Use Disorder on Buprenorphine.Cureus · 2023Article
- A Closer Look at Opioid-Induced Adrenal Insufficiency: A Narrative Review.International journal of molecular sciences · 2023Review
- The Changing Epidemiology of Adrenal Insufficiency: Iatrogenic Factors Predominate.Journal of the Endocrine Society · 2023Article
- Opioid-induced adrenal insufficiency: diagnostic and management considerations.Frontiers in endocrinology · 2023Review
- Perioperative Evaluation and Management of Patients on Glucocorticoids.Journal of the Endocrine Society · 2022Review
- Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data.Journal of the Endocrine Society · 2022Article
- Cortisol values during the standard-dose cosyntropin stimulation test: Personal experience with Elecsys cortisol II assay.Frontiers in endocrinology · 2022Article
- Rethinking the management of immune checkpoint inhibitor-related adrenal insufficiency in cancer patients during the COVID-19 pandemic.Endocrinology, diabetes & metabolism · 2021Review
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
contextChronic opioid use may lead to adrenal insufficiency because of central suppression of the hypothalamic-pituitary-adrenal axis. However, the prevalence of opioid-induced adrenal insufficiency (OIAI) is unclear.
objectiveTo determine the prevalence of OIAI and to identify predictors for the development of OIAI in patients taking opioids for chronic pain.
designCross-sectional study, 2016-2018.
settingReferral center. PATIENTS: Adult patients taking chronic opioids admitted to the Pain Rehabilitation Center.
main outcome measureDiagnosis of OIAI was considered if positive case detection (cortisol < 10 mcg/dL, ACTH < 15 pg/mL, and dehydroepiandrosterone sulfate < 25 mcg/dL), and confirmed after endocrine evaluation. Daily morphine milligram equivalent (MME) was calculated.
resultsIn 102 patients (median age, 53 years [range, 22-83], 67% women), median daily MME was 60 mg (3-840), and median opioid therapy duration was 60 months (3-360). Abnormal case detection testing was found in 11 (10.8%) patients, and diagnosis of OIAI was made in 9 (9%). Patients with OIAI were on a higher daily MME (median, 140 [20-392] mg vs 57 [3-840] mg, P = 0.1), and demonstrated a 4 times higher cumulative opioid exposure (median of 13,440 vs 3120 mg*months, P = 0.03). No patient taking <MME of 20 mg/day developed OIAI (sensitivity of 100% for MME > 20 mg); however, specificity of MME cutoff >20 mg was only 19%. After opioid discontinuation, 6/7 patients recovered adrenal function.
conclusionThe prevalence of OIAI was 9%, with MME cumulative exposure being the only predictor for OIAI development. Patients on MME of 20 mg/day and above should be monitored for OIAI.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.