Testosterone deficiency in non-cancer opioid-treated patients

Coluzzi, Flaminia; Billeci, Domenico; Maggi, Mario; Corona, Giovanni

doi:10.1007/s40618-018-0964-3

Cited by 59 publications

(54 citation statements)

References 127 publications

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“…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%

“…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 . The abuse of anabolic‐androgenic steroids (AAS) and, in particular, their withdrawal after long‐term use represents another increasingly serious issue, which may not always be immediately apparent unless there is a high level of suspicion and awareness by the clinician .…”

Section: Treatmentmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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

et al. 2020

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“…One of the possible consequence of androgen deficiency is impaired bone mass density, as detected by dual-energy X-ray absorptiometry (DEXA) scan. The first observations were recorded in opioid abusers using very high doses of opioids, and in patients under methadone maintenance treatment [55]. Strong analgesics with a reduced activity on MOR have been shown to have a lower impact on the endocrine system of chronic pain patients [56].…”

Section: Analgesicsmentioning

confidence: 99%

Pain Management in Patients with Multiple Myeloma: An Update

Coluzzi

Rolke

Mercadante

2019

Cancers

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Most patients with multiple myeloma (MM) suffer from chronic pain at every stage of the natural disease process. This review focuses on the most common causes of chronic pain in MM patients: (1) pain from myeloma bone disease (MBD); (2) chemotherapy-induced peripheral neuropathy as a possible consequence of proteasome inhibitor therapy (i.e., bortezomib-induced); (3) post-herpetic neuralgia as a possible complication of varicella zoster virus reactivation because of post-transplantation immunodepression; and (4) pain in cancer survivors, with increasing numbers due to the success of antiblastic treatments, which have significantly improved overall survival and quality of life. In this review, non-pain specialists will find an overview including a detailed description of physiopathological mechanisms underlying central sensitization and pain chronification in bone pain, the rationale for the correct use of analgesics and invasive techniques in different pain syndromes, and the most recent recommendations published on these topics. The ultimate target of this review was to underlie that different types of pain can be observed in MM patients, and highlight that only after an accurate pain assessment, clinical examination, and pain classification, can pain be safely and effectively addressed by selecting the right analgesic option for the right patient.

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“…Considering that a secondary HG is by far more prevalent than the primary one, understanding the molecular mechanism(s) leading to a comorbidity-dependent hypothalamic-pituitary failure is relevant. In a minority of cases, secondary HG could be associated with other potentially reversible conditions, such as use or abuse of opiates and anabolic androgens as well as hyperprolactinemia [3,13]. In all these cases of secondary HG, the Endocrine Society suggests that removing the underlying noxious condition may have a beneficial effect on HG, along with obvious additional health benefits [3].…”

mentioning

confidence: 99%