Primary adrenal insufficiency in adults

To the Editor: I read with keen interest the review article on primary adrenal insufficiency in adults by Drs. Lundholm, Ambalavanan, and Rao.¹ The authors mention that secondary adrenal insufficiency is more common than primary adrenal insufficiency and is most often associated with long-term exogenous steroid use.¹

The United States is facing an opioid epidemic, with 1 in 10 Americans experiencing chronic pain.² Opioids cause adrenal insufficiency by suppressing the hypothalamic-pituitary-adrenal axis. The incidence is reported to be 9% to 29% in patients receiving long-term opiate therapy.² Given the widespread use of both legal and illegal opioids, secondary adrenal insufficiency should be considered in patients who present with symptoms of adrenal insufficiency like fatigue, nausea, vomiting, weight loss, and muscle pain.

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