Chronic use of opioids and the endocrine system.

Opioids are widely used for the management of acute and chronic pain. They are also abused for recreational purposes. Long term use may lead to abnormalities in the endocrine system. The axis mainly affected is the gonadal axis leading to hypogonadism. However adrenal insufficiency and growth hormone deficiency can also occur with evidence that other hormones are affected to a lesser extent. No large randomised controlled trials have been performed; however, evidence from several small studies on heroin addicts and chronic pain patients support the above. Hence it is important to consider hormonal abnormalities in patients on long term opioids and if suspected appropriate assessment would be warranted.