SHM Converge Scientific Abstract ePoster Gallery-High-Dose Methadone-Induced Hypoglycemia With Pituitary Dysfunction: A Case Report Highlighting Diagnostic and Management Challenges

High-Dose Methadone-Induced Hypoglycemia With Pituitary Dysfunction: A Case Report Highlighting Diagnostic and Management Challenges

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This case report describes a 49-year-old transgender woman with end-stage renal disease on hemodialysis and high-dose methadone for opioid use disorder who developed recurrent severe hypoglycemia, hyponatremia, and hyperkalemia during hospitalization for hypovolemic shock. Her presentation initially raised concern for adrenal insufficiency, sepsis, liver dysfunction, and dialysis-related metabolic issues, but these common causes were systematically excluded.<br /><br />Endocrine evaluation showed a preserved cortisol response to cosyntropin stimulation, arguing against primary adrenal failure, but additional testing revealed hyperprolactinemia and suppressed gonadotropins, consistent with central pituitary dysfunction. Based on the overall clinical picture, the authors concluded that methadone was likely causing a dual endocrinopathy: opioid-related pituitary axis suppression plus a rare hypoglycemic effect.<br /><br />The mechanism of methadone-induced hypoglycemia is not fully understood, but prior reports suggest it may directly stimulate insulin secretion, producing hyperinsulinemic, hypoketotic hypoglycemia. In this patient, repeated glucose readings in the 30s–40s supported a persistent and clinically significant effect. Because opioid-induced endocrine abnormalities can mimic adrenal crisis or other acute illnesses, diagnosis may be delayed.<br /><br />The patient was discharged on hydrocortisone and levothyroxine for presumed central adrenal and thyroid dysfunction. The report emphasizes the need for clinicians to consider methadone-associated endocrine toxicity in patients with unexplained hypoglycemia, hypotension, hyponatremia, or pituitary abnormalities. Careful hormonal testing and review of methadone dose are important to prevent recurrence and reduce morbidity.

Asset Subtitle

Tanya Eftekhari

Meta Tag

Author List Angela Pham, Anna Gabrielle Manuel, Matthew Clarke, Melika Pirodan, Ralph Garcia Pacheco, Tanya Eftekhari

Category Clinical Vignettes

Concept Methadone

Concept Hypothalamic-Pituitary-Adrenal Axis

Concept Hypoglycemia

Concept Opioid Therapy

Concept Endocrinopathy

Distinguished Non-Finalist

Presenter Organization Kern Medical Center

Presenting Author Tanya Eftekhari

Track Adult

Keywords

methadone

hypoglycemia

endocrine dysfunction

opioid use disorder

hemodialysis

hyponatremia

hyperkalemia

pituitary suppression

hyperprolactinemia

adrenal insufficiency

Methadone

Hypothalamic-Pituitary-Adrenal Axis

Hypoglycemia

Opioid Therapy

Endocrinopathy