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open access

Vol 8, No 2 (2009)
Case reports
Published online: 2009-03-30
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Opioid-induced hypogonadism in palliative care. Does it matter? Report on four patients treated with hormone substitution

Emma Roantree, Zbigniew Zylicz
Advances in Palliative Medicine 2009;8(2):69-74.

open access

Vol 8, No 2 (2009)
Case reports
Published online: 2009-03-30

Abstract

Many patients treated for a long time with opioids develop hypogonadotrophic hypogonadism with deficiencies in dehydroepiandrosterone sulphate (DHEA-S) and testosterone. It is thought that hypogonadism results in the symptoms of fatigue, depressed mood, slower cognition, increased pain sensitivity, amenorhoea and loss of libido. It is debatable but quite possible that hypogonadism may also be one of the reasons of opioid tolerance. Substitution of the hormones; testosterone and/or DHEA may potentially break this vicious cycle, restore pain sensitivity to opioids and improve other symptoms improving patient's quality of life. In this article we describe four patients with intractable pain treated compassionately with either DHEA or testosterone. From the observations done by us, it is clear that substitution of those hormones has potentially a profound effect on opioid activity, both aimed and adverse effects. Suggestions for future studies are made.

Abstract

Many patients treated for a long time with opioids develop hypogonadotrophic hypogonadism with deficiencies in dehydroepiandrosterone sulphate (DHEA-S) and testosterone. It is thought that hypogonadism results in the symptoms of fatigue, depressed mood, slower cognition, increased pain sensitivity, amenorhoea and loss of libido. It is debatable but quite possible that hypogonadism may also be one of the reasons of opioid tolerance. Substitution of the hormones; testosterone and/or DHEA may potentially break this vicious cycle, restore pain sensitivity to opioids and improve other symptoms improving patient's quality of life. In this article we describe four patients with intractable pain treated compassionately with either DHEA or testosterone. From the observations done by us, it is clear that substitution of those hormones has potentially a profound effect on opioid activity, both aimed and adverse effects. Suggestions for future studies are made.
Get Citation

Keywords

opioid induced hypogonadism; testosterone; DHEA; pain sensitivity; opioid tolerance

About this article
Title

Opioid-induced hypogonadism in palliative care. Does it matter? Report on four patients treated with hormone substitution

Journal

Advances in Palliative Medicine

Issue

Vol 8, No 2 (2009)

Pages

69-74

Published online

2009-03-30

Bibliographic record

Advances in Palliative Medicine 2009;8(2):69-74.

Keywords

opioid induced hypogonadism
testosterone
DHEA
pain sensitivity
opioid tolerance

Authors

Emma Roantree
Zbigniew Zylicz

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