Chronic opioid use can have negative effects on the endocrine system. Some of the published literature I have seen indicates that this is more likely with short acting than with long-acting opioids.
Is anyone aware of research specifically examining chronic (dependent) use of long-acting opioids (whether medical, illicit, or in agonist-replacement pharmacotherapy), and problems with hormone regulation?
I am particularly interested in anything that can demonstrate whether endocrine dysfunction generally, and/or hypo- or hyper-thyroidism are a more likely consequence of long-acting opioids or shorter acting ones, and also whether there is any evidence as to whether these problems are more likely with full-agonists (eg methadone) than with partial agonists (eg buprenorphine).
I do not have any research on opioids or opioids influence on the endocrine system. However, as an endocrinologist, I see many patients with various endocrine diseases who are on chronic opioid therapy. The common denominator in men is low FSH, LH and testosterone. Some other pituitary hormones may also be affected usually with low values. TSH is affected in less extent, but it is always low with normal or low normal thyroid hormones. No hyperthyroidism.
It would be interesting to look specifically for prolactin levels, because I almost never found its values high and always find them low-normal.
If opioids act at hypothalamic level shouldn't prolactin be high? Do opioids act directly on the hypophysis ?
Thanks Carlos,
You wrote; >
This definitely is not my area of expertise, but doesn't a low level of TSH potentially indicate hyperthyroidism, and a high level of TSH indicate hypothyroidism? (My understanding is that the pituitary releases more Thyroid Stimulating Hormone in response to an underactive thyroid gland, and vice-versa- please explain if I have this backwards?).
re Opioids and effects on hypothalamus;
http://www.jneurosci.org/content/28/11/2814.full.pdf
.
http://www.ncbi.nlm.nih.gov/pubmed/12689609
.
http://www.canadianpainsociety.ca/congres/victoria2008/Presentations/Session207_Imran.pdf
.
http://www.jaoa.org/content/109/1/20.full
.
Paul.
Hi Paul:
You have it correct.
TSH responds to thyroid hormones, when they are low, TSH is high and viceversa. This happens in a normal environment. Primary hypothyroidism has low thyroid hormones and high TSH and primary hyperthyroidism occurs with high thyroid hormones and low TSH. In the case of secondary or tertiary hypothyroidism TSH is low and thyroid hormones are low. The difference between secondary and tertiary is in the TRH value, that cannot be measured peripherally that is low in tertiary and high in secondary. My comment about prolactin has to do with this issue of secondary or tertiary, because, as you know, prolactin has an inhibitor factor from the hypothalamus (Dopamine). In case of a tertiary problem TRH is low and TSH is low, but dopamine may be low and Prolactin will be high.
In reference to your question I see many Veteran patients who are on chronic opioid therapy and they develop secondary (or tertiary?) hypogonadism. I have no opportunity to see the effects of acute administration of opioids on the pituitary hormones, but what I see is that they have low gonadotropines and low testosterone values.
All the best,
Carlos
It should also be mentioned that there have been more and more studies demonstrating an association between TBI and neuroendocrine dysfunction. So that could be an additional factor to consider, especially concerning veterans returning from the wars in Iraq and Afghanistan.
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