REPORT
Nobel Med 2015; 11(1): 94-96

PITUITARY ADRENAL INSUFFICIENCY IN A CANCER PATIENT UNDER OPIOID TREATMENT

Fatma Avcı Merdin, Alparslan Merdin, Melek Karakurt Eryılmaz, Safiye Arık, Şeyda Gündüz, Hasan Şenol Coşkun, Hasan Altunbaş
ABSTRACT
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 patient’s 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.
Keywords
Opioid treatment Adrenal insufficiency Malignancy

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  • Pubmed Style
    Fatma Avcı Merdin, Alparslan Merdin, Melek Karakurt Eryılmaz, Safiye Arık, Şeyda Gündüz, Hasan Şenol Coşkun, Hasan Altunbaş. [PITUITARY ADRENAL INSUFFICIENCY IN A CANCER PATIENT UNDER OPIOID TREATMENT]. Nobel Med 2015; 11(1): 94-96, English.
  • Web Style
    Fatma Avcı Merdin, Alparslan Merdin, Melek Karakurt Eryılmaz, Safiye Arık, Şeyda Gündüz, Hasan Şenol Coşkun, Hasan Altunbaş. [PITUITARY ADRENAL INSUFFICIENCY IN A CANCER PATIENT UNDER OPIOID TREATMENT]. www.nobelmedicus.com/en/Article.aspx?m=1716 [Access: Mayıs 24, 2021], English.
  • AMA (American Medical Association) Style
    Fatma Avcı Merdin, Alparslan Merdin, Melek Karakurt Eryılmaz, Safiye Arık, Şeyda Gündüz, Hasan Şenol Coşkun, Hasan Altunbaş. [PITUITARY ADRENAL INSUFFICIENCY IN A CANCER PATIENT UNDER OPIOID TREATMENT]. Nobel Med 2015; 11(1): 94-96, English.
  • Vancouver/ICMJE Style
    Fatma Avcı Merdin, Alparslan Merdin, Melek Karakurt Eryılmaz, Safiye Arık, Şeyda Gündüz, Hasan Şenol Coşkun, Hasan Altunbaş. [PITUITARY ADRENAL INSUFFICIENCY IN A CANCER PATIENT UNDER OPIOID TREATMENT]. Nobel Med (2015); 11(1): 94-96, [cited Mayıs 24, 2021], English.
  • Harvard Style
    Fatma Avcı Merdin, Alparslan Merdin, Melek Karakurt Eryılmaz, Safiye Arık, Şeyda Gündüz, Hasan Şenol Coşkun, Hasan Altunbaş. (2015) [PITUITARY ADRENAL INSUFFICIENCY IN A CANCER PATIENT UNDER OPIOID TREATMENT]. Nobel Med, 11(1): 94-96, English.