Opioid Endocrinopathy: a Clinical Problem in Patients with Cancer Pain

Abstract

ABSTRACT Introduction: Opioids are commonly used in cancer pain management. In this study, we planned to investigate the occurance of endocrine dysfunction in cancer pain patients treated with opioids. Methods: The study included 20 patients who had cancer related pain. All data included malignant tumors diagnosed and followed up at the Oncology Clinic of University Hospital of Akdeniz between May 2009 and December 2013. Serum samples were collected for hypophyseal,gonadal and thyroid hormones(GH, ACTH, TSH, Prolactine, FSH, LH, testestorone,fT4, fT3). The inclusion criteria were chronic cancer pain, daily treatment with morphine equivalant daily dose(MEDD) of ≥25 mg/dL for at least 1 months and VAS( Visual analog score) score below 2. Patients with a history of cranial radiation, cranial surgery, pituitary tumors, adrenal metastasis, brain metastasis, anxiety, major depressive disorder, alcoholism, having an acute or chronic infection, cachexia, obesity, uncontrolled pain management or hormone replacement therapy were excluded. In addition, patients currently taking drugs that might interfere with pituitary function and that might interfere with endocrine system such as magestrol acetate, continous steroid usage over three weeks, tamoxifene, anastrozole, metoclopromide or psychiatric drugs were not included in the study. Lastly, all independent predictors were evaluated by using logistic regression analysis. Results: We did not find any significant relationships between MEDD and sex, level of ACTH, cortisole, prolactine, TSH, free T4, FSH, LH. However, level of testosterone (P= 0.040) and level of free testosterone (P= 0.041) is significantly affected by MEDD(Figure 1). On the otherhand, prolactin level was determined to be on a rising trend in increasing of MEDD (P=0.083). Lastly, MEDD is significantly affected by age (P= Conclusions: We found that opioid theraphy in patients with cancer may inhibit gonadal function and may cause hyperprolactinemia. Disclosure: All authors have declared no conflicts of interest.