WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Associate Professor Adel Ekladious*

ABSTRACT

Opiates are commonly used for pain relief and palliation. It is a proof of concept that morphine suppresses the hypothalamic-pituitary-adrenal axis. It can also suppress the pituitary-gonadal axis and cause vague symptoms in the form of tiredness, weakness, dizziness and postural giddiness. Even in short-term use of opiates, secondary and tertiary adrenal failure is a common side effect that remains under recognized among physicians. Even in cases where an accurate diagnosis of adrenal failure is made, a patient may be commenced on a course of steroids, and ceasing opiates is a concept often under-appreciated or forgotten. In this article, we report a patient treated by a rheumatologist for presumed polymyalgia rheumatica. The patient was exposed to multiple expensive investigations and received an unnecessary course of long-term steroid before reaching an accurate diagnosis and morphine ceased with resolution of all symptoms. Clinicians should have a low threshold for diagnosing opiate induced secondary adrenal insufficiency prior to commencing a patient on steroids.