Opioid-induced secondary adrenal insufficiency presenting as hypercalcaemia

[摘要] Adrenal insufficiency is a rare cause of hypercalcaemia and should be considered when more common causes such asprimary hyperparathyroidism and malignancy are excluded. Opioid therapy as a cause of adrenal insufficiency is a possiblyunder-recognised endocrinopathy with potentially life-threatening adverse effects. We report on a case of opioid-inducedsecondary adrenal insufficiency presenting as hypercalcaemia. The patient was a 25-year-old man who developedhypercalcaemia during the recovery stage after a period of critical illness. Systematic investigation of his hypercalcaemiafound it to be due to secondary adrenal insufficiency, developing as a consequence of methadone opioid analgesia.Treatment with i.v. saline and subsequent glucocorticoid replacement led to resolution of the hypercalcaemia.The hypoadrenalism resolved when opioids were subsequently weaned and ceased. These two interacting endocrinopathiesof opioid-induced adrenal insufficiency and consequent hypercalcaemia highlight the importance of maintaining awarenessof the potentially serious adverse clinical outcomes which can occur as a result of opioids, particularly considering thatsymptoms of hypoadrenalism can overlap with those of concomitant illness. Treatment with hydration and glucocorticoidreplacement is effective in promptly resolving the hypercalcaemia due to hypoadrenalism. Hypoadrenalism due to prescribedand recreational opioids may be more common than is currently recognised.

[学科分类] 血液学

[关键词] Adult;Male;White;Australia;Adrenal;Adrenal;PTH;Cortisol;Iatrogenic disorder;Adrenal insufficiency;Hypercalcaemia;Calcium (serum);Calcium (urine);PTH;Cortisol (9am);ACTH;IGF1;FT4;Albumin;Magnesium;Phosphate (serum);Vitamin D;Saline;Hydrocortisone;Glucocorticoids;Methadone;Opioids;Unusual effects of medical treatment;July;2015