Located throughout the body, the main G-protein-coupled opioid receptors, mu-opioid receptors (MOR), delta opioid receptors (DOR), and kappa opioid receptors (KOR), respond to endogenous and exogenous opioids and suppress the HPA axis. Better guidance for diagnosis and treatment is urgently needed, particularly in light of the fact that 5% of the United States population has a prescription for chronic opioid therapy. OIAI can be treated and for patients who must continue opioid therapy, it can be clinically managed. This may be dangerous, as OIAI can lead to a potentially life-threatening adrenal crisis. OIAI can be diagnosed by a variety of tests, such as the morning cortisol test, but cutoff values are not well established and it is estimated that only about 10% of patients with OIAI will ever be properly diagnosed. Beyond chronic opioid use, risk factors for OIAI are not well known. OIAI is secondary to long-term opioid use and differs from primary adrenal insufficiency. Among several opioid-associated endocrinopathies, opioid-associated adrenal insufficiency (OIAI) is both common and not well understood by most clinicians, particularly those outside of endocrine specialization.
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