{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T04:56:19Z","timestamp":1764046579552,"version":"3.40.4"},"reference-count":10,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,9,9]]},"abstract":"<jats:p>Loperamide is the most commonly used antidiarrhoeal medication in the UK. We report a serious and hitherto undocumented adverse effect of chronic use in a 45-year-old man with inflammatory bowel disease. He presented to the endocrine clinic with fatigue and low libido; biochemical assessment revealed hypogonadism and adrenal insufficiency without any elevated adrenocorticotropic hormone. When symptoms allowed, loperamide was reduced and a short synacthen test (SST) showed a \u2018clear pass\u2019 with a normal peak cortisol of 833\u2005nmol\/L. Later, worsening diarrhoea necessitated an escalation in loperamide use again. While taking a daily dose of 15\u201320\u2005mg (recommended daily maximum 16\u2005mg) reassessment revealed a fall in peak cortisol on SST to 483\u2005nmol\/L, a subnormal response. Clinicians should exercise caution when relying on loperamide to manage their patients\u2019 chronic diarrhoea and remain mindful of the possibility of drug-induced life-threatening adrenal insufficiency.<\/jats:p>","DOI":"10.1136\/bcr-2016-216384","type":"journal-article","created":{"date-parts":[[2016,9,28]],"date-time":"2016-09-28T15:29:30Z","timestamp":1475076570000},"page":"bcr2016216384","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Loperamide-induced hypopituitarism"],"prefix":"10.1136","volume":"2016","author":[{"given":"Catherine","family":"Napier","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Earn H","family":"Gan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon H S","family":"Pearce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,9,28]]},"reference":[{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.1","unstructured":"Health & Social Care Information Centre Prescription Cost Analysis, England. 2014 (publication date: April 08, 2015). http:\/\/www.hscic.gov.uk\/catalogue\/PUB17274 (accessed 24 Jun 2015)."},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2011.06.001"},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.3","doi-asserted-by":"publisher","DOI":"10.1016\/0376-8716(85)90014-6"},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.4","doi-asserted-by":"publisher","DOI":"10.1016\/0039-128X(73)90002-0"},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.5","doi-asserted-by":"publisher","DOI":"10.1054\/jpai.2002.126790"},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2005.01483.x"},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.7","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1202851"},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-011-0992-9"},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1986.tb03276.x"},{"key":"2025042705234110000_2016.sep28_1.bcr2016216384.10","doi-asserted-by":"publisher","DOI":"10.1210\/jc.75.2.552"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-216384","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T12:23:51Z","timestamp":1745756631000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-216384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9,28]]},"references-count":10,"alternative-id":["10.1136\/bcr-2016-216384"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-216384","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2016,9,28]]}}}