Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-20T17:34:26.507Z Has data issue: false hasContentIssue false
  • English
  • Français

Hypogonadism in an opioid dependent man

Published online by Cambridge University Press:  13 June 2014

Nnamdi Nkire ,
Michael Doran  and
John J O'Connor
Nnamdi Nkire*
Affiliation:
Our Lady's Hospital Navan, Ireland
Michael Doran
Affiliation:
The Drug Treatment Centre Board, McCarthy Centre, 30-31 Pearse Street, Dublin 2, Ireland
John J O'Connor
Affiliation:
The Drug Treatment Centre Board, McCarthy Centre, 30-31 Pearse Street, Dublin 2, Ireland
*
*Correspondence Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

We describe here the case of a 45-year-old man with a chronic history of heroin abuse who has received methadone maintenance therapy for 12 years. At admission, on this occasion, for stabilisation on methadone, he reported a two-year history of painful gynaecomastia and testicular atrophy. Investigations revealed abnormal sex hormone levels. Liver function tests, thyroid function tests, Brain (pituitary) MRI and viral screens were normal. Following assessment and abnormality in two morning total testosterone level measurements he was diagnosed with hypogonadism secondary to opioid use. Although he had a previous history of alcohol abuse, he was abstinent from alcohol use for five years at time of assessment. He was commenced on parenteral testosterone replacement with therapeutic benefit.

In light of the increased use of opioids, it is important to recognise and manage the endocrine complications of opioid use. The need for an empathic and adequate sexual history, physical examination and investigation is essential in patients who use opioids to ensure that cases of hormonal dysfunction are detected early and managed appropriately.

Keywords

EndocrineHypogonadismOpioidsGynaecomastiaTestosterone
Type
Case report
Information
Irish Journal of Psychological Medicine , Volume 28 , Issue 3 , September 2011 , pp. 168 - 170
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cicero, T. Effects of exogenous and endogenous opiates on the hypothalamicpituitary-gonadal axis in the male. Fed Proc 1980; 39(8): 2551–2554.Google ScholarPubMed
2.Drolet, G, Dumont, EC, Gosselin, I, Kinkead, R, Laforest, S, Trottier, JF. Role of endogenous opioid system in the regulation of the stress response. Prog Neuropsychopharmacol Biol Psy 2001; 25(4): 729–741.CrossRefGoogle ScholarPubMed
3.Genazzani, AR, Genazzani, AD, Volpogni, Cet al.Opioid control of gonadotrophin secretion in humans. Hum Reprod 1993; 8(2): 151–153.CrossRefGoogle ScholarPubMed
4.Grossman, A, Moult, PJ, Gaillard, RCet al.The opioid control of LH and FSH release: effects of a met-enkephalin analogue and naloxone. Clin Endocr (Oxf) 1981; 14(1): 41–47.CrossRefGoogle ScholarPubMed
5.Jordan, D, Tafani, JAM, Ries, Cet al.Evidence for multiple opioid receptors in the human posterior pituitary. J Neuroendocr 1996; 8: 883–887.CrossRefGoogle ScholarPubMed
6.Veldhuis, JD, Rogol, AD, Samojlik, E, Ertel, N. Role of endogenous opiates in the expression of negative feedback actions of androgen and estrogen on pulsatile properties of luteinizing hormone secretion in man. J Clin Invest 1984; 74:47–55.CrossRefGoogle ScholarPubMed
7.Ceccarelli, I, De Padova, AM, Fiorenzani, P, Massafra, C, Aloisi, AM. Single opioid administration modifies gonadal steroids in both the CNS and plasma of male rats. Neurosc 2006; 140: 929–937.CrossRefGoogle ScholarPubMed
8.De la rossa, RE, Hennessey, JV. Hypogonadism and methadone: Hypothalamic hypogonadism after long-term use of high dose methadone. Endocr Pract 1996; 2: 4–7.CrossRefGoogle Scholar
9.Bliesener, N, Albrecht, S, Schwager, A, Weckbecker, K, Lichtermann, D, Klingmuller, D. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endoc Metab 2005; 90: 203–206.CrossRefGoogle ScholarPubMed
10.Yen, SSC, Quigley, ME, Reid, RLet alNeuroendocrinology of opioid peptides and their role in the control of gonadotropin and prolactin secretion. Am J Obst Gyn 1985; 152: 485–493.CrossRefGoogle ScholarPubMed
11.Daniel, HW. Narcotic-induced hypogonadism during therapy for heroin addiction. J Addict Dis 2002; 21(4): 47–53.CrossRefGoogle Scholar
12.Mendelson, JH, Mello, NK. Plasma testosterone levels during chronic heroin use and protracted abstinence. A study of Hong Kong addicts. Clin Pharmacol Ther 1975; 17(5): 529–533.CrossRefGoogle ScholarPubMed
13.Dorlands pocket medical dictionary, 26th ed. 2001: 417.Google Scholar
14.Stanworth, RD, Jones, TH. Testosterone for the ageing male; current evidence and recommended practice. Clin Interv Aging 2008; 3: 25–44.Google ScholarPubMed
15.Daniel, HW. Opioid-induced androgen defiency. Current Opinion in Endocr Diab 2006; 13(3): 262–266.CrossRefGoogle Scholar
16.Daniel, HW. Opioid Endocrinopathy in Women Consuming Prescribed Sustained-Action Opioids for Control of Non-malignant Pain. J Pain 2008; 9(1): 28–36.CrossRefGoogle Scholar
17.Zylicz, Z. Opioid-induced hypognadism: the role of androgens in the well-being and pain thresholds in men and women with advanced disease. Adv Pall Med 2009; 8(2): 57–62.Google Scholar
18.Nathaniel, K. The Impact of Opioids on the Endocrine System. Pain Mgt Round 2005; 1(9). www.painmanagementrounds.org.Google Scholar
19.Molly, MS, Alvin, MM, Kevin, LS, Daniel, RK. Low serum testosterone and mortality in male veterans. Arch Intern Med 2006; 166: 1660–1665.Google Scholar
20.Rhoden, EL, Morgentaler, A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 2004; 350: 482–492.CrossRefGoogle ScholarPubMed