A 36-year-old woman presents for preoperative assessment. She is receiving 60 mg of controlled-release morphine twice daily, in addition to intermittent-release morphine as needed. Levels of which of the following are MOST likely to be decreased during the perioperative period as a result of her opioid use?
The chronic use of opioids is associated with adrenal insufficiency secondary to suppression of the hypothalamic-pituitary-adrenal axis. Among patients receiving at least 100 mg of oral morphine equivalents daily for more than a year, it is estimated that 9%-29% will develop opioid-induced adrenal insufficiency. Symptoms may include nausea, vomiting, fatigue, dizziness, and muscle aches. Adrenal insufficiency can be challenging to diagnose, as similar symptoms may be seen in patients with chronic pain syndrome. Factors associated with an increased risk of low basal cortisol and adrenal insufficiency include female sex, increased body mass, and younger age.
In the perioperative period, adrenal insufficiency may result...
