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Evidence of Hypothalamic-Pituitary-Adrenal and -Gonadal Dysfunction in Cocaine-Addicted Men.

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Ersche, Karen D 
Stochl, Jan 
Brühl, Annette B 
Gurnell, Mark 


INTRODUCTION: Regular cocaine use has been associated with hormonal dysfunction including hypogonadism, which can lead to fatigue, reduced stamina, sexual dysfunction, and impaired quality of life. However, cocaine's endocrine effects are largely under-reported in the scientific addiction literature and, in many cases, are not addressed within treatment services. The low profile of these adverse effects might be attributable to a lack of awareness and linkage with cocaine use, such that they are recognized only when an acute/emergency problem arises. METHODS: We assessed endocrine diurnal function (adrenocorticotrophic hormone [ACTH], cortisol, and testosterone) in 26 healthy and 27 cocaine-dependent men and examined changes in hormone levels in response to a single 40 mg dose of the noradrenaline re-uptake inhibitor atomoxetine in a double-blind, placebo-controlled experimental medicine study. RESULTS: When compared with healthy controls, diurnal and atomoxetine-induced changes in ACTH and cortisol showed greater variability in cocaine-dependent men. Interestingly, despite an exaggerated rise in ACTH following atomoxetine, an attenuated cortisol response was observed, and one-third of cocaine-dependent men had subnormal testosterone levels. CONCLUSION: Our findings point to a potential disconnection between the pituitary and adrenal responses in cocaine-dependent men, a higher rate of hypogonadism, and a pressing need for more research into the endocrine effects of cocaine and their clinical implications.



Adrenocorticotrophic hormone, Cortisol, Hypogonadism, Opioids, Testosterone, Male, Humans, Hydrocortisone, Atomoxetine Hydrochloride, Quality of Life, Adrenocorticotropic Hormone, Cocaine-Related Disorders, Cocaine, Hypothalamo-Hypophyseal System, Hypogonadism, Testosterone, Substance-Related Disorders, Pituitary-Adrenal System

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Eur Addict Res

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S. Karger AG
Medical Research Council (MR/J012084/1)
The study was funded by the Medical Research Council (MR/J012084/1) and supported by the NIHR Cambridge Biomedical Research Centre (NIHR203312) and the NIHR Applied Research Collaboration East of England. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The study was jointly sponsored by Cambridge University Hospitals NHS Trust and the University of Cambridge.