{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:46:45Z","timestamp":1787014005647,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to (1) examine the diagnosis of opioid\u2010induced adrenal insufficiency, and (2) investigate the diagnostic value of a morning cortisol &lt;83\u2009nmol\/L (3\u2009\u00b5g\/dl) for the diagnosis of adrenal insufficiency, using newer more specific cortisol assays and cut\u2010offs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective study (5\/2015\u201310\/2020).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Cohort 1 (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200975): adults who underwent cosyntropin stimulation testing and opioid exposure for &gt;30 days. Cohort 2 (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009854): adults, with or without opioid exposure, who had a morning cortisol level measured the same day as stimulation testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Peak cortisol during cosyntropin stimulation testing. Sensitivity and specificity of morning serum cortisol for adrenal insufficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of adrenal insufficiency in patients with chronic opioid exposure who underwent cosyntropin stimulation testing was 4.0% using a cortisol cutoff of &lt;405\u2009nmol\/L (14.7\u2009\u00b5g\/dl) versus 19% using the traditional cutoff of &lt;500\u2009nmol\/L (18.1\u2009\u00b5g\/dl). For hospitalized patients with and without opioid\u2010exposure, 14 of 22 (64%) patients with morning cortisol levels of &lt;83\u2009nmol\/L (3\u2009\u00b5g\/dl) passed cosyntropin stimulation testing. A morning cortisol level of &lt;348\u2009nmol\/L (12.6\u2009\u00b5g\/dl) had 100% sensitivity (95% confidence interval: 84.5%\u2013100%) for the diagnosis of adrenal insufficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Applying a cutoff of &lt;405\u2009nmol\/L (14.7\u2009\u00b5g\/dl), opioid\u2010induced adrenal insufficiency is rare. Nearly 1 out of 6 patients would be reclassified as having adrenal insufficiency applying the guideline\u2010recommended cutoff of &lt;500\u2009nmol\/L (18.1\u2009\u00b5g\/dl). Serum morning cortisol &lt;83\u2009nmol\/L (3\u2009\u00b5g\/dl) is not a valid diagnostic test for adrenal insufficiency in hospitalized patients, whether or not receiving opioids.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.14587","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T00:20:06Z","timestamp":1631146806000},"page":"21-29","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The biochemical diagnosis of adrenal insufficiency with modern cortisol assays: Reappraisal in the setting of opioid exposure and hospitalization"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9062-8667","authenticated-orcid":false,"given":"Caitlin","family":"Colling","sequence":"first","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Nachtigall","sequence":"additional","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly M. K.","family":"Biller","sequence":"additional","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen K.","family":"Miller","sequence":"additional","affiliation":[{"name":"Neuroendocrine Unit Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Substance Abuse and Mental Health Services Administration.Key Substance Use and Mental Health Indicators in the United States: Results From the 2018 National Survey on Drug Use and Health(HHS Publication No. PEP19\u20105068 NSDUH Series H\u201054). Rockville MD: Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration (2019).\u00a0Accessed January 15 2021https:\/\/www.samhsa.gov\/data\/"},{"key":"e_1_2_6_3_1","unstructured":"U.S Department of Health and Human Services. The opioid epidemic by the numbers.\u00a02019. Accessed October 22 2020.https:\/\/www.hhs.gov\/opioids\/about-the-epidemic\/index.htm"},{"key":"e_1_2_6_4_1","unstructured":"National Institute on Drug Abuse. Goal 4: Increase the public health impact of NIDA research.\u00a0Accessed October 22 2020.https:\/\/www.drugabuse.gov\/about-nida\/strategic-plan\/goal-4-increase-public-health-impact-nida-research"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e6333"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiz133"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofw157"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa499"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.85.6.6615"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13125"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgz022"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1923.64.3.506"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0024-3205(83)90529-5"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-57-3-592"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2009-0009"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-18-0530"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvab022"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0376-8716(85)90014-6"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1530\/acta.0.1050149"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-32-2-266"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2016-2118"},{"key":"e_1_2_6_22_1","unstructured":"CDC compilation of benzodiazepines muscle relaxants stimulants zolpidem and opioid analgesics with oral morphine milligram equivalent conversion factors 2018 version. 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