Loperamide-induced hypopituitarism

Misdiagnosis of hypopituitarism as gastroenteritis: A case report

BACKGROUND

The clinical manifestations of pituitary dysfunction are atypical, complex, and diverse, which can easily lead to misdiagnosis.

CASE SUMMARY

A 72-years-old male patient was admitted to the hospital due to "intermittent diarrhea for more than 10 years". He has previously been diagnosed with gastroenteritis, and the efficacy of oral administration of "norfloxacin and smecta" was not satisfactory. During hospitalization, he had mental symptoms such as delayed response, drowsiness, and difficulty answering questions. Upon examination, thyroid hormone levels, sex hormone levels, and cortisol levels were significantly reduced. Pituitary magnetic resonance imaging showed empty sella and pituitary compression, indicating hypopituitarism. After receiving glucocorticoid treatment, the patient's consciousness returned to normal and his diarrhea disappeared.

CONCLUSION

The clinical manifestations of hypopituitarism are atypical, complex, and diverse, which makes it prone to misdiagnosis and missed diagnosis. If not diagnosed and treated in a timely manner, pituitary crisis may occur, endangering patients' life. Hypofunction of the pituitary gland is not uncommon in clinical practice. For patients with dry and pale skin, poor elasticity or swelling, anemia, anorexia, constipation, hair loss, fear of cold, indifferent expression, low pitch, slow response, weakness, loss of appetite, nausea, vomiting, weight loss, slow heart rate, low heart sound, decreased blood pressure, hypoglycemia, etc., hypofunction of the pituitary gland should be considered.

Less Well-Known Consequences of the Long-Term Use of Opioid Analgesics: A Comprehensive Literature Review

BACKGROUND

The adverse effects of short-term opioid analgesics are well known and acknowledged; however, the spectrum of the sequelae of long-term use seems less clear. Some effects may remain undetected but still have the potential to cause harm and reduce patients' quality of life.

OBJECTIVE

To review the literature on the adverse effects of long-term opioid therapy.

METHODS

We performed a quasi-systematic search, analyzing articles published in the MEDLINE database between January 2000 and March 2021 that identified adverse effects of opioids used for chronic pain treatment.

RESULTS

Growing evidence indicates that there are multiple serious adverse effects of opioid treatment. Long-term opioid use may have significant effects on the endocrine, immune, cardiovascular, respiratory, gastrointestinal, and neural systems. Studies show that long-term opioid treatment increases the risk of fractures, infections, cardiovascular complications, sleep-disordered breathing, bowel dysfunction, overdose, and mortality. Opioids may potentially affect cancer development. Most consequences of the long-term use of opioids have been identified in studies of patients with non-malignant pain.

CONCLUSION

Studies indicate that long-term use of opioids increases the risk of drug-related events in a significant number of patients. Clinicians should be aware of these complications associated with prescribing opioids, discuss them with patients, prevent complications, if possible, and diagnose them early and manage adequately. More human studies are needed to assess the risk, including trials with individual opioids, because they have different adverse effect profiles.

[Opioid-induced adrenal insufficiency: Case report and synthesis of the literature]

INTRODUCTION

Opioid therapy for pain relief is associated with several adverse effects. Herein, we report the potential consequences of opioid use on the adrenal function.

OBSERVATION

A 49-year-old woman with sickle cell anemia (Hemoglobin SS) was admitted for the treatment of a vaso-occlusive crisis. Morphine was used for pain management, provided by intravenous intermittent dosing (patient-controlled analgesia). She developed during the hospitalization low blood pressure, due to secondary adrenal insufficiency (cortisol 74 nmol/L; ACTH 2.9pmol/L). Pituitary gland was normal on brain magnetic resonance imaging and adrenal function recovered after morphine discontinuation.

CONCLUSION

Opioids suppress cortisol secretion, primarily mediated by direct negative effect on hypothalamus and pituitary gland. Further studies are needed to define the incidence and the clinical significance of opioid-induced adrenal insufficiency, as well as the need for hormone replacement.