Opioid-Induced Adrenal Insufficiency (OIAI)

Patient selection: chronic opioid use, either for chronic pain or as substance abuse

Manifestations of the adrenal insufficiency may include:

(1) fatigue

(2) headache

(3) musculoskeletal or abdominal pain

Associated manifestations may include:

(1) hypercalcemia

(2) secondary amenorrhea in women or hypogonadism in men

(3) pituitary dysfunction

An adrenal crisis may occur, especially if there are other risk factors for adrenal insufficiency such as critical illness, serious infection or trauma.