Opioids and pituitary function: expert opinion

Gadelha, Mônica R.; Karavitaki, Niki; Fudin, Jeffrey; Bettinger, Jeffrey J; Raff, Hershel; Ben-Shlomo, Anat

doi:10.1007/s11102-021-01202-y

Cited by 18 publications

(12 citation statements)

References 90 publications

(126 reference statements)

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“…On the other hand, the opioid receptor activation reduced GnRH, associated with low gonadotropin levels and high prolactin levels and then decreased serum T levels (Gadelha et al, 2022;Jaschke et al, 2021).…”

Section: Regulation Of Testosterone Secretionmentioning

confidence: 99%

“…Kisspeptin, neurokinin B and dynorphin are peptides coexpressed in the hypothalamus, directly regulating GnRH secretion and thus pituitary secretion of gonadotropins (Skorupskaite & Anderson, 2022). On the other hand, the opioid receptor activation reduced GnRH, associated with low gonadotropin levels and high prolactin levels and then decreased serum T levels (Gadelha et al, 2022; Jaschke et al, 2021).…”

Section: Androgensmentioning

confidence: 99%

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Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review

2022

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Sexual delinquency is a global problem where those with paraphilic disorders, such as paedophiles, are more likely to commit and reoffend. Androgen deprivation therapy (ADT) has been suggested as a solution. The objective of this narrative review is to present current information on its risks, benefits and limitations as a treatment for paraphilias. The importance of testosterone in sexual function, the effect of its deficiency by age or by pharmacological treatment (anti‐androgens, GnRH agonists and GnRH antagonists) and the effect of testosterone replacement therapy will be reviewed. The relationship between androgens, brain, sexual behaviour and pathophysiology of paraphilic disorders will also be explored. ADT reduces sexual urges, but has adverse effects and, because its reversible nature, it does not ensure less recidivism. Likewise, the research quality of ADT drugs is limited and not enough to support their use. Child sex offenders, and not paraphilic subjects who have not committed assaults, show signs of elevated prenatal exposure to androgens and a higher methylation state of the androgen receptor gene. Sexual behaviour is regulated by subcortical (hypothalamus, brainstem and spinal cord) and cortical structures of the brain, in addition to brain circuits (dopaminergic, serotonergic). Those with paraphilic disorders show abnormalities at these levels that could relate to the risk of sexual offences. In conclusion, androgens represent a significant part of the pathophysiology of paraphilias and therefore, ADT seems promising. Nonetheless, more studies are needed to make definite conclusions about the efficacy of long‐term ADT in paraphilic patients.

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Section: Regulation Of Testosterone Secretionmentioning

confidence: 99%

Section: Androgensmentioning

confidence: 99%

Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review

2022

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“…20 The chronic effect of narcotics on the function of the HPA axis has been recognized as a common cause of suppression of the adrenal and gonadal axis. 21 Hypothalamus-Pituitary-Thyroid Axis (HPT)…”

Section: Dovepressmentioning

confidence: 99%

Treating Hypopituitarism in the Over 65s: Review of Clinical Studies

Paragliola¹,

Locantore²,

Corsello³

et al. 2023

CIA

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The current increase of life expectancy is associated with the presence of endocrine diseases in the elderly. The management of hypopituitarism in this group of patients is a challenging task. A correct diagnosis, which represents an essential requisite for an appropriate medical treatment, can be difficult because of the physiological changes occurring in pituitary function with aging, which may lead to challenges in the interpretation of laboratory results. Furthermore, the treatment requires several careful considerations: the need to restore the hormonal physiology with replacement therapies must be balanced with the need to avoid the risks of the over-replacement, especially in the presence of concomitant cardiovascular and metabolic disease. Interactions with other drugs able to modify the absorption and/or the metabolism of hormonal replacement therapies should be considered, in particular for the treatment of hypoadrenalism and hypothyroidism. The most important challenges stem from the lack of specific studies focused on the management of hypopituitarism in older people.

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“…In former studies, opioid intake has been linked to hypogonadism (Aloisi et al, 2009;Diasso et al, 2021;Gadelha et al, 2022;Gudin et al, 2015;Katz & Mazer, 2009). Opioid intake has been shown to suppress and alter the pulsatile secretion of GnRH in the hypothalamus, decrease gonadotropin secretion by the pituitary gland and also decrease steroidogenesis in the gonads (Fountas et al, 2018;Vuong et al, 2010).…”

Section: High/low-dose Opioidmentioning

confidence: 99%

Long‐term opioid treatment and endocrine measures in chronic non‐cancer pain patients

Diasso

Abou-Kassem

Nielsen

et al. 2023

European Journal of Pain

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BackgroundThe prevalence of chronic non‐cancer pain (CNCP) has increased dramatically the past decades, which combined with indiscriminate use of prescribed opioids has become a public health problem. Endocrine dysfunction may be a complication of long‐term opioid treatment (L‐TOT), but the evidence is limited. This study aimed at investigating the associations between L‐TOT and endocrine measures in CNCP patients.MethodsCortisol (spot and after stimulation), thyrotropin (TSH), thyroxin (T4), insulin‐like growth factor 1 (IGF‐1), prolactin (PRL), 17‐hydroxyprogesterone, androstenedione, dehydroepiandrosterone (DHEAS), sex hormone‐binding globulin (SHBG), total testosterone (TT) and free testosterone (fT) were measured. Group comparisons were done between CNCP patients in L‐TOT and controls as well as between patients on high‐ or low‐dose morphine equivalents.ResultsEighty‐two CNCP patients (38 in L‐TOT and 44 controls not receiving opioids) were included. Low TT (p = 0.004) and fT concentrations (p < 0.001), high SHBG (p = 0.042), low DEAS (p = 0.017) and low IGF‐1 (p = 0.003) in men were found when comparing those in L‐TOT to controls and high PRL (p = 0.018), low IGF‐1 standard deviation score (SDS) (p = 0.006) along with a lesser, but normal cortisol response to stimulation (p = 0.016; p = 0.012) were found when comparing L‐TOT to controls. Finally, a correlation between low IGF‐1 levels and high opioid dose was observed (p < 0.001).ConclusionsOur study not only supports previous findings but even more interestingly disclosed new associations. We recommend future studies to investigate endocrine effects of opioids in larger, longitudinal studies. In the meanwhile, we recommend monitoring endocrine function in CNCP patients when prescribing L‐TOT.SignificanceThis clinical study found associations between L‐TOT, androgens, growth hormone and prolactin in patients with CNCP compared to controls. The results support previous studies as well as add new knowledge to the field, including an association between high opioid dose and low growth hormone levels. Compared to existing research this study has strict inclusion/exclusion criteria, a fixed time period for blood sample collection, and adjustments for potential confounders, which has not been done before.

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Opioids and pituitary function: expert opinion

Cited by 18 publications

References 90 publications

Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review

Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review

Treating Hypopituitarism in the Over 65s: Review of Clinical Studies

Long‐term opioid treatment and endocrine measures in chronic non‐cancer pain patients

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