PITUITARY ADRENAL INSUFFICIENCY IN A CANCER PATIENT UNDER OPIOID TREATMENT

Merdin F. A., Eryilmaz M. K., Arik S., Gunduz S., COŞKUN H. Ş., Altunbas H.

NOBEL MEDICUS, cilt.11, sa.1, ss.94-96, 2015 (ESCI) identifier

  • Yayın Türü: Makale / Editöre Mektup
  • Cilt numarası: 11 Sayı: 1
  • Basım Tarihi: 2015
  • Dergi Adı: NOBEL MEDICUS
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus
  • Sayfa Sayıları: ss.94-96
  • Anahtar Kelimeler: Opioid treatment, adrenal insufficiency, malignancy
  • Akdeniz Üniversitesi Adresli: Evet

Özet

Opioid induced suppression of the hypothalamic-pituitary-adrenal axis is rare and mostly misdiagnosed in clinical handling. Weakness and debility are nonspecific symptoms that are seen in chronic cancer patients. Here, we report a case of adrenal crisis in a patient using opioid for malignancy related pain. A 65 year-old woman with lung and anorectum cancer had been referred to our hospital. She had been under 15 days of opioid therapy because of bone metastasis related cancer pain. She complained of back pain, weakness, weight loss, fatigue and hypotension. The patient was evaluated with suspected adrenal insufficiency. She had adrenocortical and pituitary insufficiency with adrenal crisis. Plasma ACTH and cortisol levels were detected low. Pituitary failure was diagnosed and hypophysis MRI showed reduced hypophysis volume (diameter) without heterogeneity; hypophysis height was stated as 4 mm. Prednisolone treatment was started and the patients symptoms and complaints improved. These symptoms might be attributed to an underlying malignant disease, but one should always keep in mind adrenocortical insufficiency in case of chronic high-dose opioid usage.