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Opioid-Induced Endocrinopathy — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesOpioid-Induced EndocrinopathyRACP Adult Medicine

A 55-year-old man with chronic pain on long-term opioids (morphine 100 mg daily oral equivalent) develops progressive hypogonadism (low testosterone, low LH/FSH), adrenal suppression, and osteoporosis. What is this condition collectively termed?

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Correct answer: D — Chronic pain syndrome

Opioid-induced endocrinopathy (OIE) is a collective term for the endocrine effects of chronic opioid therapy, affecting up to 90% of patients. Central GnRH suppression causes hypogonadotropic hypogonadism (low testosterone/oestrogen, low LH/FSH); HPA axis suppression can cause secondary adrenal insufficiency (especially relevant during acute illness – sick day crisis); and reduced growth hormone secretion also occurs. The optimal management is opioid dose reduction/rotation. If opioids cannot be reduced, testosterone replacement may be considered.

Reference: eTG – 2025 – Endocrinology; AMH – 2025 – Opioid Adverse Effects