4 The prevalence of OIAI among patients receiving long-term opioids ranges from 8.3% to 29%. While high-dose opioids may acutely suppress the HPA axis, 3 OIAI is more commonly associated with long-term opioid use. Recognition of OIAI is critical given the current opioid epidemic and life-threatening consequences of AI in systemically ill patients. Chronic, high-dose opioids can suppress the hypothalamic-pituitary-adrenal (HPA) axis and cause secondary, or central, adrenal insufficiency (AI). 2 Hospitalists frequently encounter common opioid side effects such as constipation, nausea, and drowsiness, but may be less familiar with their effects on the endocrine system. 1 Patients using high doses of opioids for greater than 3 months are 40%-50% more likely to be hospitalized than those on a lower dose or no opioids. In the United States, 5.4% of the population is currently using long-term opioids. How is OIAI diagnosed and managed? Brief overview of issue
