Key messages
- Adrenal insufficiency (as highlighted in the NHSGGC Non-Malignant Pain Opioid guideline) is a possible side effect of long-term opioid prescribing.
- Despite the fact that opioids are clearly linked to various endocrinopathies, OIAI has not been well-researched and is thought to be largely under-recognised in practice.
- Routine testing is not recommended if the patient is well. However, if the patient has symptoms of adrenal insufficiency (e.g. fatigue, weight loss, low blood pressure, fainting, increased thirst, low mood) then an early morning cortisol test is recommended, with referral to endocrinology if cortisol is low
- OIAI has been reported with wide ranges in median duration of use, median morphine equivalent daily dose and estimated prevalence.
- As there is no specific dose or duration of treatment associated with the development of OIAI the risk is expected to be higher with the cumulative exposure to the opioid.