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

Vries, Friso de; Bruin, Mees; Lobatto, Daniel J.; Dekkers, Olaf M.; Schoones, Jan W; Furth, Wouter R. van; Pereira, Alberto M; Karavitaki, Niki; Biermasz, Nienke R.; Najafabadi, Amir H Zamanipoor

doi:10.1210/jcemdgz022

Cited by 8 publications

(11 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other drugs may interfere with androgen receptor‐mediated action in target tissues (). Opioid treatment in men with chronic non‐cancer pain (CNCP) is one of the most frequently encountered examples of drug‐induced functional hypogonadism . Opioid medication withdrawal usually normalizes T concentrations within 1 month .…”

Section: Treatmentmentioning

confidence: 99%

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

et al. 2020

View full text Add to dashboard Cite

Background Evidence regarding functional hypogonadism, previously referred to as ‘late‐onset’ hypogonadism, has increased substantially during the last 10 year. Objective To update the European Academy of Andrology (EAA) guidelines on functional hypogonadism. Methods Expert group of academicians appointed by the EAA generated a series of consensus recommendations according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Results The diagnosis of functional hypogonadism should be based on both the presence of clinical symptoms supported by repeatedly low morning fasting serum total testosterone (T) measured with a well‐validated assay, after exclusion of organic causes of hypogonadism. Lifestyle changes and weight reduction should be the first approach in all overweight and obese men. Whenever possible, withdrawal/modification of drugs potentially interfering with T production should be advised. Testosterone replacement therapy (TRT) is contraindicated in men with untreated prostate or breast cancer, as well as severe heart failure. Severe low urinary tract symptoms and haematocrit >48%‐50% represent relative contraindications for TRT. Prostate‐specific antigen and digital rectal examination of the prostate should be undertaken in men >40 years of age before initiating TRT to exclude occult prostate cancer. Transdermal T should be preferred for initiation of TRT, whereas gonadotrophin therapy is only recommended when fertility is desired in men with secondary hypogonadism. TRT is able to improve sexual function in hypogonadal men. Other potential positive outcomes of TRT remain uncertain and controversial. Conclusion TRT can reliably improve global sexual function in men with hypogonadism in the short term. Long‐term clinical benefits, and safety of TRT in functional hypogonadism, remain to be fully documented. Clinicians should therefore explicitly discuss the uncertainties and benefits of TRT and engage them in shared management decision‐making.

show abstract

Section: Treatmentmentioning

confidence: 99%

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Evidence related to the effects of opioids on the somatotropic and hypothalamic–pituitary–thyroid axes is inconclusive; however, hyperprolactinaemia appears to be common. 68…”

Section: Increasing Opioid Use and The Acute Hospital Settingmentioning

confidence: 99%

“…Patients taking opioids long term can develop an opioid-induced endocrinopathy resulting from suppression of the hypothalamic-pituitary-gonadal or hypothalamic-pituitary-adrenal axes, leading to hypogonadism (especially low levels of testosterone) and secondary adrenal insufficiency, respectively. [66][67][68] The latter endocrinopathy is less well known and less well studied. It is said to affect around one-fifth of all patients compared with a rate of hypogonadism of nearly two-thirds in male patients.…”

Section: Endocrinopathiesmentioning

confidence: 99%

“…It is said to affect around one-fifth of all patients compared with a rate of hypogonadism of nearly two-thirds in male patients. 68 It may, however, be more important in the acute care setting, as adrenal insufficiency could result in a blunting of the patient's stress response after surgery or other injury/illness and possible hypotension. Evidence related to the effects of opioids on the somatotropic and hypothalamic-pituitary-thyroid axes is inconclusive; however, hyperprolactinaemia appears to be common.…”

Section: Endocrinopathiesmentioning

confidence: 99%

See 1 more Smart Citation

The opioid epidemic from the acute care hospital front line

Macintyre

2021

Anaesth Intensive Care

View full text Add to dashboard Cite

Prescription opioid use has risen steeply for over two decades, driven primarily by advocacy for better management of chronic non-cancer pain, but also by poor opioid stewardship in the management of acute pain. Inappropriate prescribing, among other things, contributed to the opioid ‘epidemic’ and striking increases in patient harm. It has also seen a greater proportion of opioid-tolerant patients presenting to acute care hospitals. Effective and safe management of acute pain in opioid-tolerant patients can be challenging, with higher risks of opioid-induced ventilatory impairment and persistent post-discharge opioid use compared with opioid-naive patients. There are also increased risks of some less well known adverse postoperative outcomes including infection, earlier revision rates after major joint arthroplasty and spinal fusion, longer hospital stays, higher re-admission rates and increased healthcare costs. Increasingly, opioid-free/opioid-sparing techniques have been advocated as ways to reduce patient harm. However, good evidence for these remains lacking and opioids will continue to play an important role in the management of acute pain in many patients. Better opioid stewardship with consideration of preoperative opioid weaning in some patients, assessment of patient function rather than relying on pain scores alone to assess adequacy of analgesia, prescription of immediate release opioids only and evidence-based use of analgesic adjuvants are important. Post-discharge opioid prescribing should be contingent on an assessment of patient risk, with short-term only use of opioids. In partnership with pharmacists, nursing staff, other medical specialists, general practitioners and patients, anaesthetists remain ideally positioned to be involved in opioid stewardship in the acute care setting.

show abstract

“…High fertility levels can be found in France (59 %), 26 % -32 % in the UK and Kashmir Valley in India, and about 36 % in South Africa, Indonesia and Finland. Moreover, it has been shown that mean sperm concentration has regional variation in men from different regions of the USA and France [2] ( Mehta et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Sever Oligospermia Treatment with Testicular Sperm Using ICSI

Zakaria¹,

Al-Ibraheemi²,

Ennaji³

et al. 2021

Preprint

View full text Add to dashboard Cite

Assisted reproductive technology has been developed significantly throughout the past few years, particularly diagnosing and treating male infertility. Many studies have been performed showing that Intracytoplasmic Sperm Injection (ICSI) is a successful method to attain clinical pregnancy and live birth through impaired spermatozoa characteristics or low sperm count, such as severe oligospermia. Severe oligospermia indicates low sperm count, which in some cases leads to azoospermia. Severe oligospermia can be caused by several factors such as genetics or medication. In search of efficient treatment for couples with Severe oligospermia, numerous retrospective and prospective researches have reported high pregnancy and live birth rates through testicular sperm for men with severe oligospermia and cryptozoospermia with or without high sperm DNA damage. The research showed that the use of testicular sperm in combination with ICSI yielded a high pregnancy rate and live births over another source of sperm, such as ejaculated sperms. Moreover, the use of ICSI in severe oligospermia has shown successful fertilization and pregnancy.

show abstract

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

Cited by 8 publications

References 0 publications

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males

The opioid epidemic from the acute care hospital front line

Sever Oligospermia Treatment with Testicular Sperm Using ICSI

Contact Info

Product

Resources

About