Opioid-Induced Androgen Deficiency (OPIAD)

Opioid therapy is one of the most effective forms of analgesia currently in use. In the past few decades, the use of opioids as a long-term treatment for chronic pain has increased dramatically. Accompanying this upsurge in the use of long-term opioid therapy has been an increase in the occurrence of opioid associated endocrinopathy, most commonly manifested as an androgen deficiency and therefore referred to as opioid associated androgen deficiency (OPIAD). This syndrome is characterized by the presence of inappropriately low levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) leading to inadequate production of sex hormones, particularly testosterone. Symptoms that may manifest in patients with OPIAD include reduced libido, erectile dysfunction, fatigue, hot flashes, and depression. Physical findings may include reduced facial and body hair, anemia, decreased muscle mass, weight gain, and osteopenia or osteoporosis. Additionally, both men and women with OPIAD may suffer from infertility. While the literature regarding OPIAD remains limited, it is apparent that OPIAD is becoming increasingly prevalent among chronic opioid consumers but often goes unrecognized. OPIAD can have a significant negative impact on the the quality of life of opioid users, and clinicians should anticipate the potential for its occurrence whenever long-term opioid prescribing is undertaken. Once diagnosed, treatment for OPIAD may be offered utilizing a number of androgen replacement therapy options including a variety of testosterone preparations and, for female patients with OPIAD, dehydroepiandrosterone (DHEA) supplementation. Follow-up evaluation of patients receiving androgen replacement therapy should include a review of any unresolved symptoms of hypogonadism, laboratory evaluation, and surveillance for potential adverse effects of androgen replacement therapy including prostate disease in males. Key words: Opioid, hypogonadism, testosterone, endocrine, androgen

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Advances in the Management of Parkinsons Disease

Scottish Medical Journal ◽

10.1177/003693307602100317 ◽

1976 ◽

Vol 21 (3) ◽

pp. 139-148 ◽

Cited By ~ 7

Author(s):

C. D. Marsden

Keyword(s):

Side Effects ◽

Replacement Therapy ◽

Term Treatment ◽

Parkinsons Disease ◽

Complex Time ◽

Optimum Dosage ◽

New Approaches ◽

Long Term Treatment ◽

Near Future

The treatment of Parkinson's disease today is complex, time-consuming, but rewarding. The introduction of levodopa has not cured the disease, but has provided the most powerful therapy available yet. Its use is limited by side effects and careful titration to optimum dosage, often in combination with other drugs, is required. Despite best therapy, some patients never respond, and others begin to lose benefit after some years of therapy. New problems, such as the ‘on-off’ effect have appeared with long-term treatment, and require careful adjustment of dosage. As with any replacement therapy, a balance between sub-optimal benefit and side effects has to be discovered and maintained by careful and frequent review. New approaches to treatment may offer further improvement in the near future.

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Long-term use of fentanyl pectin nasal spray in patients with breakthrough pain in cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9563 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9563-9563

Author(s):

Donald Taylor ◽

Lukas Radbruch ◽

Julia Revnic ◽

Luis M. Torres ◽

John E Ellershaw ◽

...

Keyword(s):

Nasal Spray ◽

Breakthrough Pain ◽

Controlled Trial ◽

Oral Morphine ◽

Opioid Therapy ◽

Term Treatment ◽

Open Label ◽

Patients With Cancer ◽

Long Term Treatment

9563 Background: Given that patients with cancer are living longer, there is a need to ensure that treatments used for palliative care are well tolerated and effective during long-term use. The objective of this study was to investigate the use of fentanyl pectin nasal spray (FPNS) for the treatment of breakthrough pain in cancer (BTPc) in patients taking regular opioid therapy. Methods: A total of 401 adult patients, taking at least 60 mg/day oral morphine or equivalent, with an average of 1 to 4 episodes of BTPc per day, who were either newly enrolled or had completed a randomized controlled trial with FPNS, entered into an open-label assessment study (NCT00458510). Of these, 171 patients, continued into an extension period. Up to 4 episodes of BTPc per day were treated with FPNS at titrated doses between 100 µg and 800 µg. Patients returned to the clinic at 4-week intervals for assessment and reporting of any adverse events (AEs). Results: There were 163 patients with documented FPNS use. The mean duration of use was 325 days; 46 patients used FPNS for more than 1 year, while the maximum duration was 3 years and 8 months. In total, 2% of patients withdrew from the study due to lack of efficacy. Seventy-four percent of patients did not change their FPNS dose. The most common AEs, aside from disease progression, were: insomnia, 9.9%; nausea, 9.4%; vomiting, 9.4%; and peripheral edema, 9.4%. The overall incidence of treatment-related AEs was 11.1%, the most common being constipation (4.1%), with no apparent dose relationship. Ten patients (5.8%) experienced treatment-related nasal AEs, which, with the exception of 1 severe event, were all mild or moderate. Conclusions: FPNS appeared to provide a sustained benefit and was well tolerated during the long-term treatment of BTPc. Clinical trial information: NCT00458510.

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Long Term Treatment with Enzyme Replacement Therapy in Patients with Fabry Disease

Nephron ◽

10.1159/000448968 ◽

2016 ◽

Vol 134 (1) ◽

pp. 30-36 ◽

Cited By ~ 18

Author(s):

Daniel Oder ◽

Peter Nordbeck ◽

Christoph Wanner

Keyword(s):

Enzyme Replacement Therapy ◽

Fabry Disease ◽

Replacement Therapy ◽

Term Treatment ◽

Enzyme Replacement ◽

Long Term Treatment

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Neither long-term treatment with raloxifene nor hormone replacement therapy modulate cardiac function in healthy postmenopausal women: Two randomized, placebo-controlled, 2-year studies

American Journal of Obstetrics and Gynecology ◽

10.1067/mob.2002.122092 ◽

2002 ◽

Vol 186 (4) ◽

pp. 729-736 ◽

Cited By ~ 13

Author(s):

Tatjana E. Vogelvang ◽

Velja Mijatovic ◽

Otto Kamp ◽

J.Coen Netelenbos ◽

Simone J.M. Neele ◽

...

Keyword(s):

Hormone Replacement Therapy ◽

Cardiac Function ◽

Replacement Therapy ◽

Postmenopausal Women ◽

Hormone Replacement ◽

Term Treatment ◽

Long Term Treatment

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State of lipid metabolism in patients receiving androgen replacement therapy

Perm Medical Journal ◽

10.17816/pmj37520-26 ◽

2021 ◽

Vol 37 (5) ◽

pp. 20-26

Author(s):

P. S. Popov ◽

I. A. Kournikova ◽

V. I. Torshin ◽

N. N. Malyutina

Keyword(s):

Cardiovascular Risk ◽

Lipid Metabolism ◽

Replacement Therapy ◽

Negative Impact ◽

Modern Medicine ◽

Testosterone Replacement Therapy ◽

Androgen Deficiency ◽

Androgen Replacement Therapy ◽

Individual Adjustment ◽

Dose Dependent

Objective. To assess the state of lipid metabolism indicators and predict cardiovascular risk in patients with secondary (acquired) hypogonadism on the background of androgen replacement therapy. Testosterone replacement therapy is often used in modern medicine for diagnosed androgen deficiency in patients of any age group. There are quite a lot of publications devoted to diagnosis and treatment, but the effectiveness and safety of any therapy is determined by several factors, of which two were considered in the presented study dose-dependent effect and compliance. Material and methods. Sixty two patients aged 30 to 52 years with androgen deficiency and a low risk of developing cardiovascular diseases were examined according to the Princeton Consensus criteria. Patients were divided into groups depending on the severity of androgen deficiency and the duration of therapy. Complaints, objective status, muscle strength, daily blood pressure and heart rate monitoring data, lipidogram and sex hormone indicators were evaluated. Results. The obtained data suggest that androgen replacement therapy in doses that lead to an increase in the level of testosterone in the blood above the upper limit of reference values had a negative impact on the lipid spectrum and increased cardiovascular risk for this group of patients. Conclusions. The analyzed approach to therapy of androgen deficiency should provide an individual adjustment of dosage on the background of determining the target blood testosterone level.

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INFECTIONS AND VIRILIZING ADRENAL HYPERPLASIA

PEDIATRICS ◽

10.1542/peds.25.4.563 ◽

1960 ◽

Vol 25 (4) ◽

pp. 563-564

Author(s):

MARY L. VOORHESS ◽

LYTT I. GARDNER

Keyword(s):

Infectious Diseases ◽

Replacement Therapy ◽

Adrenal Glands ◽

Term Treatment ◽

Adrenal Hyperplasia ◽

Long Term Treatment ◽

Children With Asthma

PHYSICIANS who treat children with virilizing adrenal hyperplasia frequently question the proper course of therapy that should be followed when these patients are exposed to infectious diseases. Misconceptions have developed because of a tendency to confuse these patients, who need adrenocorticosteroids only for replacement therapy, with patients having other syndromes who are receiving suppression therapy. Children with virilizing adrenal hyperplasia are given long-term treatment with physiologic amounts of adrenocorticosteroids to replace those steroids which their adrenal glands are unable to produce. It is hoped that their abnormally large adrenal glands can thus be reduced to a normal size. This is replacement therapy. Children with asthma, leukemia, nephrosis, etc., may be given large doses of steroids in an empiric effort to induce remissions in these diseases.

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Orthodontic treatment pause during COVID-19 outbreak: Are we overlooking potential harms to our patients and their treatment outcomes?

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.26.2.e21ins2 ◽

2021 ◽

Vol 26 (2) ◽

Author(s):

Feras ABED AL JAWAD ◽

Najah ALHASHIMI

Keyword(s):

Treatment Outcome ◽

Orthodontic Treatment ◽

Negative Impact ◽

Term Treatment ◽

Dental Services ◽

Emergency Situations ◽

Dental Procedures ◽

Long Term Treatment ◽

The World

ABSTRACT Introduction: The global outbreak of coronavirus disease 2019 (COVID-19) has led all dental governing bodies across the world to minimize or cancel routine/elective dental procedures and limit dental services to only acute emergency situations. Orthodontic treatment is a long-term treatment that necessitates several appointments. However, if patients are left unsupervised during this pandemic, serious harms might arise apart from acute orthodontic emergencies. Objective: In this article we highlight these harms and their negative impact on patients and the overall success of their treatment. Conclusion: We briefly presented actions needed to be undertaken by orthodontists to gradually allow for recalling patients according to the stage of their treatment to avoid any potential harms to the treatment outcome and avoid any subsequent medicolegal consequences.

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Impact of radiotherapy on long-term treatment outcomes in patients with breast cancer who have undergone simultaneous one-stage and two-stage reconstructive surgeries. Literature review

Tumors of female reproductive system ◽

10.17650/1994-4098-2021-17-3-51-58 ◽

2021 ◽

Vol 17 (3) ◽

pp. 51-58

Author(s):

T. S. Berestok ◽

I. V. Reshetov ◽

A. D. Zikiryakhodzhaev ◽

V. N. Galkin ◽

M. V. Ermoshchenkova ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Negative Impact ◽

Capsular Contracture ◽

Psychological Trauma ◽

Term Treatment ◽

Breast Cancer Patients ◽

Aesthetic Result ◽

Long Term Treatment

The evolution in reconstructive breast surgery in the form of widespread use of implants allows you to abandon the “simple” mastectomy in most patients, provide faster rehabilitation and minimize the psychological trauma due to the absence of a breast. However, in most cases, radiation therapy and/or drug treatment are necessary, as they reduce the risk of relapse, disease progression and mortality. The combined or complex treatment increases the frequency of postoperative complications, such as prolonged wound healing, infection, protrusion/extrusion of the endoprosthesis, the development of capsular contracture, seroma, hematoma, etc. The greatest negative impact on the aesthetic result, both in the early and in the long-term period, is provided by remote radiation therapy. On the other hand, performing reconstructive plastic surgery may complicate radiation therapy. The issues of how long it is necessary to conduct radiation therapy, what type of reconstruction and how to conduct radiation therapy, how to minimize the frequency of complications without compromising the oncological and aesthetic results of treatment of breast cancer patients remain controversial.

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