Opioid-induced adrenal insufficiency: diagnosis and management.

INTRODUCTION: Opioid-induced adrenal insufficiency (OIAI) is a known, but often overlooked complication associated with chronic opioid use. It is important to recognize OIAI as, if untreated, can lead to increased morbidity and mortality. AREAS COVERED: This narrative review discusses the prevalence, pathophysiology, diagnosis, and management of OIAI, with special emphasis on the current challenges. While investigations and treatment of OIAI is similar to other causes of adrenal insufficiency, it is important to recognize and test for other opioid-induced endocrinopathies. Furthermore, unlike some causes of adrenal insufficiency, OIAI has demonstrated reversibility following the discontinuation of opioids; therefore, cessation of opioids should be considered as a part of a multidisciplinary collaboration. EXPERT OPINION: Identification and appropriate treatment of patients with OIAI is important. Although recognition of this condition is increasing, further investigation is needed to identify additional risk factors to allow close follow-up of those at risk of OIAI or minimize the development OIAI.