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?

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.