Opioid-Induced Secondary Adrenal Insufficiency in a Young Patient with Chronic Pancreatitis

Opioid misuse is a national public health crisis that has contributed to a decrease in life expectancy in men and women in the US. From 1999-2017, the rate of drug overdose deaths tripled, largely due to the rise in opioid use. Despite widespread misuse, chronic opioid therapy still has a role in the clinical setting. Adverse effects include dizziness, nausea, vomiting, respiratory depression, and dependence. While these side effects are welldocumented, other effects of opioids are less explored, including opioidinduced adrenal insufficiency. The typical presentation of adrenal insufficiency from any cause can include fatigue, nausea, vomiting, weight loss, abdominal pain and muscle aches. Laboratory findings might include hyponatremia and hyperkalemia. This case, however, presents a patient with atypical presentation but confirmed diagnosis of adrenal insufficiency in the setting of chronic opioid use. Ultimately, given chronic opioid use both prescribed and unprescribed, it is imperative that healthcare providers understand the endocrine effects of opioids as adrenal insufficiency is associated with higher morbidity and mortality.