A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy

Mario Sebastian Campana; Maria Riofrio; Raja Jadav; Guido Macchiavello

doi:doi:10.11648/j.ijde.20220701.12

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A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy

Mario Sebastian Campana, Maria Riofrio, Raja Jadav, Guido Macchiavello

Published in International Journal of Diabetes and Endocrinology (Volume 7, Issue 1)

Received: 4 December 2021 Accepted: 14 January 2022 Published: 20 January 2022

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Abstract

Oral maintenance opioid agonists have an important role in the management of heroin addiction and chronic pain. Methadone is one of the most popular and effective treatments for opioid dependence, however many patients following methadone’s clinics can develop a few metabolic and sexual side effects. Methadone can induce a few hormonal disbalance over time, including hypogonadotropic hypogonadism with sexual dysfunction, muscle weakness, and decreased bone mass density. Most of the side effects are dose-related especially when methadone is above 100 mg daily. Low levels of testosterone increase the risk of erectile dysfunction, loss of libido, sexual unsatisfaction, osteopenia, and osteoporosis, giving a poor quality of life in patients on methadone maintenance therapy. We present a case of a 57 -year-old male patient complaining about erectile dysfunction and loss of libido secondary to central hypogonadism induced by methadone with decreased bone density. The purpose of this case report is to bring these patients to the primary care world and improve their management with a multidisciplinary team including primary care, endocrinologists, and psychologists. Physicians should be aware of opioid-induced endocrinopathies and address properly with early sex hormones work up, bone density screening, and encourage methadone tapering every visit.

Published in	International Journal of Diabetes and Endocrinology (Volume 7, Issue 1)
DOI	10.11648/j.ijde.20220701.12
Page(s)	13-17
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Males, Methadone, Hypogonadism, Osteoporosis, Testosterone

References

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[2]	Demarest SP, Gill RS, Adler RA: Opioid Endocrinopathy. Endocr Pract. 2015, 21: 190–9. 10.4158/EP14339.RA.
[3]	Antony T, Alzaharani SY, El-Ghaiesh SH: Opioid-induced hypogonadism: Pathophysiology, clinical and therapeutics review. Clin Exp Pharmacol Physiol. 2020, 47: 741–50. https://doi.org/10.1111/1440-1681.13246.
[4]	Reddy RG, Aung T, Karavitaki N, Wass JAH: Opioid induced hypogonadism. BMJ. 2010, 341: c4462. 10.1136/bmj.c4462.
[5]	Bawor M, Dennis BB, Samaan MC, et al.: Methadone induces testosterone suppression in patients with opioid addiction. Sci Rep. 2014, 4: 6189. 10.1038/srep06189.
[6]	Daniell HW: Hypogonadism in men consuming sustained-action oral opioids. J Pain. 2002, 3: 377–84. 10.1054/jpai.2002.126790.
[7]	de la Rosa RE, Hennessey J V: Hypogonadism and Methadone: Hypothalamic Hypogonadism after Long-Term use of High-Dose Methadone. Endocr Pract. 1996, 2: 4–7. 10.4158/EP.2.1.4.
[8]	Yee A, Loh HS, Hisham Hashim HMB, Ng CG: Clinical factors associated with sexual dysfunction among men in methadone maintenance treatment and buprenorphine maintenance treatment: a meta-analysis study. Int J Impot Res. 2014, 26: 161–6. 10.1038/ijir.2014.18.
[9]	Tabuchi Y, Yasuda T, Kaneto H, et al.: A case of hypogonadotropic hypogonadism caused by opioid treatment for nonmalignant chronic pain. Case Rep Med. 2012, 2012: 740603. 10.1155/2012/740603.
[10]	Buss T, Leppert W: Opioid-Induced Endocrinopathy in Cancer Patients: An Underestimated Clinical Problem. Adv Ther. 2014, 31: 153–67. 10.1007/s12325-014-0096-x.
[11]	Raheem OA, Patel SH, Sisul D, Furnish TJ, Hsieh T-C: The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis. Am J Mens Health. 2017, 11: 1208–13. 10.1177/1557988316672396.
[12]	Rinonapoli, G., Ruggiero, C., Meccariello, L., Bisaccia, M., Ceccarini, P., & Caraffa, A. (2021). Osteoporosis in men: A review of an underestimated bone condition. International Journal of Molecular Sciences, 22 (4), 2105. https://doi.org/10.3390/ijms22042105.
[13]	Fountas A, Van Uum S, Karavitaki N: Opioid-induced endocrinopathies. Lancet Diabetes Endocrinol. 2020, 8: 68–80. 10.1016/S2213-8587(19)30254-2.
[14]	Kim, S. D., & Cho, K. S. (2019). Obstructive Sleep Apnea and Testosterone Deficiency. The world journal of men's health, 37 (1), 12–18. https://doi.org/10.5534/wjmh.180017.

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APA Style

Mario Sebastian Campana, Maria Riofrio, Raja Jadav, Guido Macchiavello. (2022). A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy. International Journal of Diabetes and Endocrinology, 7(1), 13-17. https://doi.org/10.11648/j.ijde.20220701.12

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ACS Style

Mario Sebastian Campana; Maria Riofrio; Raja Jadav; Guido Macchiavello. A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy. Int. J. Diabetes Endocrinol. 2022, 7(1), 13-17. doi: 10.11648/j.ijde.20220701.12

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AMA Style

Mario Sebastian Campana, Maria Riofrio, Raja Jadav, Guido Macchiavello. A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy. Int J Diabetes Endocrinol. 2022;7(1):13-17. doi: 10.11648/j.ijde.20220701.12

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@article{10.11648/j.ijde.20220701.12,
  author = {Mario Sebastian Campana and Maria Riofrio and Raja Jadav and Guido Macchiavello},
  title = {A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy},
  journal = {International Journal of Diabetes and Endocrinology},
  volume = {7},
  number = {1},
  pages = {13-17},
  doi = {10.11648/j.ijde.20220701.12},
  url = {https://doi.org/10.11648/j.ijde.20220701.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20220701.12},
  abstract = {Oral maintenance opioid agonists have an important role in the management of heroin addiction and chronic pain. Methadone is one of the most popular and effective treatments for opioid dependence, however many patients following methadone’s clinics can develop a few metabolic and sexual side effects. Methadone can induce a few hormonal disbalance over time, including hypogonadotropic hypogonadism with sexual dysfunction, muscle weakness, and decreased bone mass density. Most of the side effects are dose-related especially when methadone is above 100 mg daily. Low levels of testosterone increase the risk of erectile dysfunction, loss of libido, sexual unsatisfaction, osteopenia, and osteoporosis, giving a poor quality of life in patients on methadone maintenance therapy. We present a case of a 57 -year-old male patient complaining about erectile dysfunction and loss of libido secondary to central hypogonadism induced by methadone with decreased bone density. The purpose of this case report is to bring these patients to the primary care world and improve their management with a multidisciplinary team including primary care, endocrinologists, and psychologists. Physicians should be aware of opioid-induced endocrinopathies and address properly with early sex hormones work up, bone density screening, and encourage methadone tapering every visit.},
 year = {2022}
}

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TY  - JOUR
T1  - A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy
AU  - Mario Sebastian Campana
AU  - Maria Riofrio
AU  - Raja Jadav
AU  - Guido Macchiavello
Y1  - 2022/01/20
PY  - 2022
N1  - https://doi.org/10.11648/j.ijde.20220701.12
DO  - 10.11648/j.ijde.20220701.12
T2  - International Journal of Diabetes and Endocrinology
JF  - International Journal of Diabetes and Endocrinology
JO  - International Journal of Diabetes and Endocrinology
SP  - 13
EP  - 17
PB  - Science Publishing Group
SN  - 2640-1371
UR  - https://doi.org/10.11648/j.ijde.20220701.12
AB  - Oral maintenance opioid agonists have an important role in the management of heroin addiction and chronic pain. Methadone is one of the most popular and effective treatments for opioid dependence, however many patients following methadone’s clinics can develop a few metabolic and sexual side effects. Methadone can induce a few hormonal disbalance over time, including hypogonadotropic hypogonadism with sexual dysfunction, muscle weakness, and decreased bone mass density. Most of the side effects are dose-related especially when methadone is above 100 mg daily. Low levels of testosterone increase the risk of erectile dysfunction, loss of libido, sexual unsatisfaction, osteopenia, and osteoporosis, giving a poor quality of life in patients on methadone maintenance therapy. We present a case of a 57 -year-old male patient complaining about erectile dysfunction and loss of libido secondary to central hypogonadism induced by methadone with decreased bone density. The purpose of this case report is to bring these patients to the primary care world and improve their management with a multidisciplinary team including primary care, endocrinologists, and psychologists. Physicians should be aware of opioid-induced endocrinopathies and address properly with early sex hormones work up, bone density screening, and encourage methadone tapering every visit.
VL  - 7
IS  - 1
ER  -

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Author Information

Mario Sebastian Campana

Department of Internal Medicine, St Barnabas Hospital - Albert Einstein College of Medicine, New York, United States
Maria Riofrio

Department of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
Raja Jadav

Department of Internal Medicine, St Barnabas Hospital - Albert Einstein College of Medicine, New York, United States
Guido Macchiavello

Department of Internal Medicine, St Barnabas Hospital - Albert Einstein College of Medicine, New York, United States

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APA Style

Mario Sebastian Campana, Maria Riofrio, Raja Jadav, Guido Macchiavello. (2022). A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy. International Journal of Diabetes and Endocrinology, 7(1), 13-17. https://doi.org/10.11648/j.ijde.20220701.12

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ACS Style

Mario Sebastian Campana; Maria Riofrio; Raja Jadav; Guido Macchiavello. A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy. Int. J. Diabetes Endocrinol. 2022, 7(1), 13-17. doi: 10.11648/j.ijde.20220701.12

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AMA Style

Mario Sebastian Campana, Maria Riofrio, Raja Jadav, Guido Macchiavello. A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy. Int J Diabetes Endocrinol. 2022;7(1):13-17. doi: 10.11648/j.ijde.20220701.12

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@article{10.11648/j.ijde.20220701.12,
  author = {Mario Sebastian Campana and Maria Riofrio and Raja Jadav and Guido Macchiavello},
  title = {A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy},
  journal = {International Journal of Diabetes and Endocrinology},
  volume = {7},
  number = {1},
  pages = {13-17},
  doi = {10.11648/j.ijde.20220701.12},
  url = {https://doi.org/10.11648/j.ijde.20220701.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20220701.12},
  abstract = {Oral maintenance opioid agonists have an important role in the management of heroin addiction and chronic pain. Methadone is one of the most popular and effective treatments for opioid dependence, however many patients following methadone’s clinics can develop a few metabolic and sexual side effects. Methadone can induce a few hormonal disbalance over time, including hypogonadotropic hypogonadism with sexual dysfunction, muscle weakness, and decreased bone mass density. Most of the side effects are dose-related especially when methadone is above 100 mg daily. Low levels of testosterone increase the risk of erectile dysfunction, loss of libido, sexual unsatisfaction, osteopenia, and osteoporosis, giving a poor quality of life in patients on methadone maintenance therapy. We present a case of a 57 -year-old male patient complaining about erectile dysfunction and loss of libido secondary to central hypogonadism induced by methadone with decreased bone density. The purpose of this case report is to bring these patients to the primary care world and improve their management with a multidisciplinary team including primary care, endocrinologists, and psychologists. Physicians should be aware of opioid-induced endocrinopathies and address properly with early sex hormones work up, bone density screening, and encourage methadone tapering every visit.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - A Case of Secondary Hypogonadism with Increased Risk of Fractures in a 57-year-old Male Patient on Methadone Maintenance Therapy
AU  - Mario Sebastian Campana
AU  - Maria Riofrio
AU  - Raja Jadav
AU  - Guido Macchiavello
Y1  - 2022/01/20
PY  - 2022
N1  - https://doi.org/10.11648/j.ijde.20220701.12
DO  - 10.11648/j.ijde.20220701.12
T2  - International Journal of Diabetes and Endocrinology
JF  - International Journal of Diabetes and Endocrinology
JO  - International Journal of Diabetes and Endocrinology
SP  - 13
EP  - 17
PB  - Science Publishing Group
SN  - 2640-1371
UR  - https://doi.org/10.11648/j.ijde.20220701.12
AB  - Oral maintenance opioid agonists have an important role in the management of heroin addiction and chronic pain. Methadone is one of the most popular and effective treatments for opioid dependence, however many patients following methadone’s clinics can develop a few metabolic and sexual side effects. Methadone can induce a few hormonal disbalance over time, including hypogonadotropic hypogonadism with sexual dysfunction, muscle weakness, and decreased bone mass density. Most of the side effects are dose-related especially when methadone is above 100 mg daily. Low levels of testosterone increase the risk of erectile dysfunction, loss of libido, sexual unsatisfaction, osteopenia, and osteoporosis, giving a poor quality of life in patients on methadone maintenance therapy. We present a case of a 57 -year-old male patient complaining about erectile dysfunction and loss of libido secondary to central hypogonadism induced by methadone with decreased bone density. The purpose of this case report is to bring these patients to the primary care world and improve their management with a multidisciplinary team including primary care, endocrinologists, and psychologists. Physicians should be aware of opioid-induced endocrinopathies and address properly with early sex hormones work up, bone density screening, and encourage methadone tapering every visit.
VL  - 7
IS  - 1
ER  -

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