Morphine-Induced TSH Release in Normal and Hypothyroid Subjects

Devilla, L.; Pende, Aldo; Morgano, A.; Giusti, Massimo; Musso, Natale R.; Lotti, G

doi:10.1159/000124091

Cited by 21 publications

(9 citation statements)

References 38 publications

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“…The results are consistent with previous studies on the effects of morphine on the endocrine system (Devilla et al, 1985;Vuong et al, 2010). Morphine had an effect on prolactin concentration 45 min after dosing and thus, shortly after subjective analgesia and pupillary response occurred.…”

Section: Assessment Of Subjective and Objective Measuressupporting

confidence: 92%

“…It is also well recognized that opioids generally stimulates the endocrine system (Vuong, Van Uum, O'Dell, Lutfy, & Friedman, 2010). Numerous studies, in both animals and humans, have documented the effect on prolactin levels, which therefore provides a second objective measure (Delitala, Grossman, & Besser, 1983;Devilla et al, 1985;Lo Dico et al, 1983;Vuong et al, 2010). In general, acute opioid administration stimulates prolactin secretion, while the effect of chronic opioid administration is less clear.…”

Section: Introductionmentioning

confidence: 99%

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Objective markers of the analgesic response to morphine in experimental pain research

Brokjær

Olesen

Kreilgaard

et al. 2015

Journal of Pharmacological and Toxicological Methods

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Section: Assessment Of Subjective and Objective Measuressupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Objective markers of the analgesic response to morphine in experimental pain research

Brokjær

Olesen

Kreilgaard

et al. 2015

Journal of Pharmacological and Toxicological Methods

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“…Use of the following intravenous drugs ≤8 h prior to screening was recorded: dopamine, dobutamine, furosemide, morphine, fentanyl, and hydrocortisone. From a few hours after administration, these drugs can temporarily affect thyroid hormone concentrations; pretreatment levels are reached within hours after discontinuation of the drug [4,15,16,17,18,19]. Variables with p ≤ 0.20 were included in the multiple logistic regression analysis.…”

Section: Methodsmentioning

confidence: 99%

Nationwide Evaluation of Congenital Hypothyroidism Screening during Neonatal Extracorporeal Membrane Oxygenation

et al. 2016

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Background: Thyroid hormone concentrations may deviate from normal values during critical illness. This condition is known as nonthyroidal illness syndrome (NTIS), and it can influence the results of screening for congenital hypothyroidism (CH) during neonatal extracorporeal membrane oxygenation (ECMO). Objectives: To determine the incidence of aberrant CH screening results in ECMO-treated neonates, to identify possible determinants, and to follow up patients with abnormal thyroid hormone concentrations. Methods: In this retrospective cohort study, we included 168 ECMO-treated neonates admitted from 2004 to 2014 and screened by protocol and divided them into the following 3 groups: group 1 (screened during ECMO, n = 107), group 2 (screened shortly before ECMO, n = 26), and group 3 (screened shortly after ECMO, n = 35). Results: CH screening results were aberrant in 67.3% (72/107) of the neonates screened during ECMO, in 73.1% (19/26) of the neonates screened before ECMO, and in 31.4% (11/35) of the neonates screened after ECMO (p < 0.001). Of the neonates with an aberrant screening result, all but 2 (i.e. 98%) had a low thyroxine concentration with a normal thyrotropin concentration at screening, as is seen in NTIS. None was diagnosed with CH. Mortality did not significantly differ between neonates with an aberrant screening result (32.4%) and neonates with a normal screening result (22.7%; p = 0.18). Screening before ECMO (OR 5.92; 95% CI 1.93-18.20), screening during ECMO (OR 4.49; 95% CI 1.98-10.19), and a higher Pediatric Logistic Organ Dysfunction-2 score (OR 1.31; 95% CI 1.04-1.66) were associated with an aberrant screening result. Conclusions: Aberrant CH screening results were found in most ECMO-treated neonates screened before or during ECMO, which is likely due to NTIS. Follow-up of thyroid hormone concentrations is best started after recovery from critical illness. Our results suggest that thyroxine therapy is not required during ECMO.

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“…In humans, acute intravenous administration of morphine in normal volunteers led to a significant increase in serum TSH and enhanced the response of TSH to thyrotropin-releasing hormone stimulation (110).…”

Section: :4 R190 Reviewmentioning

confidence: 97%

MECHANISMS OF ENDOCRINOLOGY: Endocrinology of opioids

Fountas

Chai

Kourkouti

et al. 2018

European Journal of Endocrinology

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The use of opioids has grown substantially over the past two decades reaching the dimensions of a global epidemic. These drugs have effects on multiple levels of the endocrine system through mechanisms which are still not fully elucidated, and awareness of their endocrine sequelae is vital for all specialists prescribing or managing patients on them. Hypogonadism is the most well recognised consequence of opioid use (prevalence 21-86%) which, however, may remain undiagnosed with potential adverse outcomes for the patients. Although less frequent, cortisol deficiency can be also found. Furthermore, there is negative impact on bone health (with reduced bone mineral density and increased fracture risk) and occasionally hyperprolactinaemia, whereas the clinical significance of alterations in other hormones remains to be clarified. Discontinuation or reduction of the opioid and, in cases of chronic pain, consideration of alternative therapies for pain relief are potential management options. Hormonal replacement, especially when the above measures are not practically feasible, needs to be considered. Further studies are needed to clearly establish the prevalence of hormonal abnormalities with various regimes, doses and routes of opioids and to address reliably the long-term benefits and risks of hormonal treatment in patients on opioids. Until evidence-based, safe and cost-effective clinical guidelines become available, periodical assessment of the gonadal and adrenal function (particularly when relevant clinical manifestations are present) and evaluation of the bone health status are advised.

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Morphine-Induced TSH Release in Normal and Hypothyroid Subjects

Cited by 21 publications

References 38 publications

Objective markers of the analgesic response to morphine in experimental pain research

Objective markers of the analgesic response to morphine in experimental pain research

Nationwide Evaluation of Congenital Hypothyroidism Screening during Neonatal Extracorporeal Membrane Oxygenation

MECHANISMS OF ENDOCRINOLOGY: Endocrinology of opioids

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