Opioids and their endocrine effects: A systematic review and meta-analysis.

de Vries, Friso, Bruin, Mees, Lobatto, Daniel J, Dekkers, Olaf M, Schoones, Jan W, van Furth, Wouter R, Pereira, Alberto M, Karavitaki, Niki, Biermasz, Nienke R and Zamanipoor Najafabadi, Amir H (2019) Opioids and their endocrine effects: A systematic review and meta-analysis. The Journal of clinical endocrinology and metabolism. ISSN 1945-7197.

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The increased use of opioids has resulted in an unprecedented opioid epidemic. Chronic opioid use causes hypogonadism, but its frequency, as well as the effects of opioids on other hypothalamo-pituitary-end organ hormone axes, remains unclear.


The aim of this systematic review and meta-analysis was to assess the effects of opioid use on pituitary function.


Eight electronic databases were searched for articles published up to May 8, 2018. Fixed- or random-effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals. This study is reported following the PRISMA- and MOOSE-guidelines.


52 studies (22 low risk of bias) were included describing 18,428 subjects, consisting of patients with chronic pain (n=21 studies), or on maintenance treatment for opioid addiction (n=9) and healthy volunteers (n=4). The most frequently used opioid was methadone (n=13 studies), followed by morphine (n=12). Prevalence of hypogonadism was 63% (95% CI: 55-70%, 15 studies, 3,250 patients, 99.5% males). Prevalence of hypocortisolism relying on dynamic and non-dynamic testing was 15% (95% CI: 6-28%, 5 studies, 205 patients, 57.5% males) and including only studies using the insulin tolerance tests 24% (95% CI 16-33%, 2 studies, n=97 patients). In 5 out of 7 studies hyperprolactinemia was present. No clear effects on the somatotropic and hypothalamo-pituitary-thyroid axes were described.


Hypogonadism occurs in more than half of male opioid users, and hypocortisolism in approximately a fifth of all patients. Periodical evaluation of at least the gonadal and adrenal axes is therefore advisable.

Item Type: Article
Subjects: WK Endocrine system. Endocrinology
Divisions: Ambulatory Care > Diabetes
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Depositing User: Mrs Yolande Brookes
Date Deposited: 13 Sep 2019 13:19
Last Modified: 13 Sep 2019 13:19
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2386

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