Opioids and pituitary function: expert opinion
Open accessAbstract
Purpose Opioids are highly addictive potent analgesics and anti-allodynics whose use has dramatically increased in recent decades. The precipitous rise in opioid dependency and opioid use disorder is an important public health challenge given the risks for severely adverse health outcomes. The long-term opioid impact on hypothalamic-pituitary axes is particularly underappreciated among both endocrinologists and primary care physicians. We review the effects of opioids on hypothalamic-pituitary-target gland function and their implications for clinical practice.Methods Experts in hypothalamic-pituitary disorders and opioid pharmacology reviewed recently published literature and considered strategies for diagnosing and managing these opioid-induced endocrine effects.Results Opioid suppression of hypothalamic-pituitary axes can lead to hypogonadotropic hypogonadism, central adrenal insufficiency, and hyperprolactinemia. These important clinical manifestations are often under-estimated, poorly evaluated, and typically either untreated or not optimally managed. Data on biochemical testing for diagnosis and on the effect of hormone replacement in these patients is limited and prospective randomized controlled studies for guiding clinical practice are lacking.Conclusions Patients should be informed about risks for hypogonadism, adrenal insufficiency, and hyperprolactinemia, and encouraged to report associated symptoms. Based on currently available evidence, we recommend clinical and biochemical evaluation for potential central adrenal insufficiency, central hypogonadism, and/or hyperprolactinemia in patients chronically treated with opioids as well as the use of current expert guidelines for the diagnosis and treatment of these conditions.
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Opioids can cause hyperprolactinemia, most likely by inhibiting hypothalamic dopamine production.
“Opioids can cause hyperprolactinemia, most likely by inhibiting the hypothalamic dopamine production (49,141).”
From Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement (2024) · cites this paper as [49]
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Self-citation
- Authors
- Gadelha, M. R., Karavitaki, N., Fudin, J., Bettinger, J. J., Raff, H., & Ben-Shlomo, A.
- Affiliations
- Universidade Federal do Rio de Janeiro (BR)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Western New England University (US)
- Saratoga Hospital (US)
- Medical College of Wisconsin (US)
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Raff, Hershel
- ORCID
- Venue
- Pituitary
- Published
- 2022-01-23
- Volume
- 25
- Issue
- 1
- Pages
- 52-63
- ISSN
- 1386-341X (ISSN-L)
- 1573-7403
- OpenAlex
- W4206961005
- Semantic Scholar
- b2fbcb65ce951368b23fccfecec85dddcb01315a
- Cited by
- 27
- References
- 90
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 8 · 2023: 10 · 2022: 2
- FWCI
- 0.89
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Pituitary (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- opioids, hypothalamic-pituitary axis, hypogonadotropic hypogonadism, secondary adrenal insufficiency, hyperprolactinemia, chronic opioid use, hormone replacement therapy, opioid use disorder
- MeSH terms
- Analgesics, Opioid, Expert Testimony, Humans, Hyperprolactinemia, Hypogonadism, Prospective Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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