Opioids are widely used for treatment of acute and chronic pain. However, opioids have several well-known clinical adverse effects such as constipation, nausea, respiratory depression and drowsiness. Endocrine dysfunctions are also opioid-induced adverse effects but remain under-diagnosed in clinical settings, especially opioid-induced adrenal insufficiency (OIAI). A 46-year-old woman was treated with transdermal fentanyl at a dose of 90–120 mg daily morphine milligram equivalent for non-malignant chronic pain for four years. Fatigue, loss of appetite and decrease in vitality began about two years after starting fentanyl. Subsequently, constipation and abdominal pain appeared and became worse, which led to suspicion of adrenal insufficiency. Clinical diagnosis of OIAI was established based on laboratory findings of secondary adrenal insufficiency, including corticotropin-releasing hormone stimulation test, clinical history of long-term fentanyl use, and exclusion of other hypothalamic-pituitary diseases. Oral corticosteroid replacement therapy was unable to relieve her abdominal pain and constipation; opioid-rotation and dose-reduction of fentanyl were not feasible because of her persistent pain and severe anxiety. While her clinical course clearly suggested that long-term, relatively high-dose transdermal fentanyl treatment may have contributed to the development of secondary adrenal insufficiency, the symptoms associated with OIAI are generally non-specific and complex. Together with under-recognition of OIAI as a clinical entity, the non-specific, wide range of symptoms can impede prompt diagnosis. Thus, vigilance for early symptoms enabling treatments including corticosteroid replacement therapy is necessary for patients taking long-term and/or high dose opioid treatment.

阿片类药物广泛用于治疗急性和慢性疼痛。然而，阿片类药物具有几种众所周知的临床副作用，例如便秘、恶心、呼吸抑制和嗜睡。内分泌功能障碍也是阿片类药物诱导的不良反应，但在临床环境中仍未得到充分诊断，尤其是阿片类药物诱导的肾上腺功能不全 (OIAI)。一名 46 岁女性接受透皮芬太尼治疗，剂量为每天 90-120 毫克吗啡毫克当量，治疗非恶性慢性疼痛四年。开始使用芬太尼大约两年后，开始出现疲劳、食欲不振和活力下降。随后出现便秘和腹痛并加重，怀疑肾上腺功能不全。OIAI 的临床诊断是基于继发性肾上腺功能不全的实验室检查结果，包括促肾上腺皮质激素释放激素刺激试验、长期使用芬太尼的临床病史，以及排除其他下丘脑-垂体疾病。口服皮质类固醇替代疗法无法缓解腹痛和便秘；由于她持续的疼痛和严重的焦虑，阿片类药物轮换和芬太尼的剂量减少是不可行的。虽然她的临床过程清楚地表明长期、相对高剂量的透皮芬太尼治疗可能导致继发性肾上腺皮质功能不全的发展，但与 OIAI 相关的症状通常是非特异性和复杂的。再加上对 OIAI 作为临床实体的认识不足，非特异性、广泛的症状可能会阻碍及时诊断。因此，