Læknablaðið - 01.07.2018, Side 25

LÆKNAblaðið 2018/104 349
Af þessum orsökum mæla sumir með því að skimað sé fyrir ein-
kennum hormónatruflana hjá sjúklingum sem taka ópíóíða, bæði
með markvissum spurningum um einkenni og jafnvel með blóð-
mælingum,1,5 en kerfisbundin skimun hefur þó ekki enn verið tek-
in upp. Engar klínískar leiðbeiningar hafa heldur verið gerðar til
þess að vekja athygli á og auðvelda læknum að takast á við þessi
vandamál. Í þeim tilfellum þar sem innkirtlastarfsemi sjúklinga
truflast vegna ópíóíðameðferðar getur þurft að minnka skammta
ópíóíðalyfja, skipta um ópíóíðalyf eða jafnvel stöðva meðferð.6
Einnig þarf að bregðast við þeim hormónatruflunum sem um er að
ræða, til dæmis með því að gefa viðeigandi hormónauppbót. Í slík-
um tilfellum þarf þá að vega og meta horfur og einkenni sjúklings,
ávinning og mögulegar aukaverkanir hormónameðferðarinnar, og
taka tillit til væntinga sjúklings.
Ljóst er að rannsaka þarf enn frekar áhrif ópíóíða á innkirtla-
starfsemi og eru íslenskir læknar hvattir til þess að hafa augun
opin fyrir ofangreindum aukaverkunum.
S J Ú K R A T I L F E L L I
1. Brennan MJ. The effect of opioid therapy on endocrine
function. Am J Med 2013; 126 (3 Suppl 1): S12-8.
2. Vuong C, Van Uum SHM, O'Dell LE, Lutfy K, Friedman
TC. The Effects of Opioids and Opioid Analogs on Animal
and Human Endocrine Systems. Endocr Rev 2010; 31:
98-132.
3. Daniell HW. Hypogonadism in men consuming sustained-
action oral opioids. J Pain 2002; 3: 377-84.
4. Colameco S, Coren JS. Opioid-induced endocrinopathy. J
Am Osteopath Assoc 2009; 109: 20-5.
5. Hallinan R, Byrne A, Agho K, McMahon C, Tynan P, Attia
J. Erectile dysfunction in men receiving methadone and
buprenorphine maintenance treatment. J Sex Med 2008; 5:
684-92.
6. Buss T, Leppert W. Opioid-induced endocrinopathy in
cancer patients: an underestimated clinical problem. Adv
Ther 2014; 31: 153-67.
7. Saunders KW, Dunn KM, Merrill JO, Sullivan M, Weisner
C, Braden JB, et al. Relationship of opioid use and dosage
levels to fractures in older chronic pain patients. J Gen
Intern Med 2010; 25: 310-5.
8. Palm S, Moenig H, Maier C. Effects of oral treatment with
sustained release morphine tablets on hypothalamic-
pituitary-adrenal axis. Methods Find Ex Clin Pharmacol
1997; 19: 269-73.
9. Allolio B, Schulte HM, Deuss U, Kallabis D, Hamel E,
Winkelman W. Effect of oral morphine and naloxo-
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human corticotropin-releasing hormone. Acta Endocrinol
(Copenh) 1987; 114: 509-14.
Heimildir
Barst til blaðsins 9. apríl 2018, samþykkt til birtingar 28. maí 2018.
Ásta Ísfold Jónasdóttir1
Jakob Jóhannsson2
Már Kristjánsson3
Rafn Benediktsson1,4
A 77-year-old woman with a history of anal squamous cell
carcinoma was admitted because of malaise, diarrhea and
nausea, in addition to back pain related to a verte-
bral compression fracture. During the course of treatment,
opioid therapy was initiated, following which the patient
became progressively hypotensive and hyponatraemic and
respiratory drive progressively decreased. Serum levels of
cortisol, TSH and LH were decreased and prolactin slight-
ly elevated, but a Synacthen test and brain MRI turned
out normal, suggesting a diagnosis of opioid-induced
pituitary dysfunction. The patient was given glucocorticoid
replacement therapy with good results. Here we present a
case of this serious but less well recognised side-effect of
opioids.
Opioid Induced Pituitary Dysfunction
ENGLISH SUMMARY
Department of Endocrinology, Landspitali University Hospital of Iceland, Faculty of Medicine, University of Iceland.

Key words: Opioid, endocrinology, endocrine dysfunction, endocrinopathy, deficiency, pain, hypopituitarism.
Correspondence: Ásta Ísfold Jónasdóttir, astaisfold@gmail.com