Dr. Amy Nett: Yeah, so opioids actually inhibit HPA axis at multiple levels. I think I realized that when I had, I think it was like a 24-year-old patient who had pretty chronic heavy opioid use and he just had a near flat line in terms of his free cortisol and total cortisol production. So opioids actually do inhibit the HPA axis at multiple levels. They suppress the HPA axis at a central level and they lead to adrenocortical insufficiency. It is actually that opioids do inhibit HPA axis and cortisol production.
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- From the HPA DUTCH section, the example of glucocorticoids creating low cortisol, low metabolites. The patient used hydrocodone, not steroids. Was that a typo or is the use of opioids a pathway that somehow leads to low cortisol?
From the HPA DUTCH section, the example of glucocorticoids creating low cortisol, low metabolites. The patient used hydrocodone, not steroids. Was that a typo or is the use of opioids a pathway that somehow leads to low cortisol?
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- You mentioned that keto is not a great idea for those with HPA axis dysfunction. Is there data to suggest keto contributes to elevated cortisol or cortisol resistance? For those who may not lose weight on keto, is this most likely due to HPA-D?
- On the topic of steroids, what are the real long-term and short-term issues when someone is on them?
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