An Unrecognized Cause of Chronic Diarrhea: Opioid-Induced Adrenal Insufficiency - A Case Report.

Opioid-induced adrenal insufficiency is an underrecognized form of secondary adrenal insufficiency caused by hypothalamic-pituitary-adrenal axis suppression and a potential but overlooked cause of chronic diarrhea. We describe a 59-year-old woman with six months of diarrhea, abdominal pain, weight loss, hypotension, and hyponatremia extensively evaluated but unrevealing for gastrointestinal etiology. Biochemical testing confirmed secondary adrenal insufficiency. Medication review revealed prior buprenorphine-naloxone exposure. Hydrocortisone therapy resulted in rapid hemodynamic improvement and resolution of gastrointestinal symptoms. Chronic gastrointestinal complaints are not always gastrointestinal in origin and should prompt consideration of endocrine etiologies, particularly in patients with opioid exposure.