Hypothalamic-pituitary-adrenal axis in long-term inhaled corticosteroid therapy for nasal polyposis

OBJECTIVE: To assess the hypothalamic-pituitary-adrenal (HPA) axis after long-term intranasal corticosteroid treatment in nasal polyposis. PATIENTS AND METHODS: A short synacthen test was performed in 24 patients who received the highest dose of inhaled beclomethasone among a population of 392 patients treated for nasal polyposis with inhaled corticosteroid therapy and short-term oral corticosteroids. RESULTS: Mean yearly dose of oral prednisone administered in shortterm treatment was 371 mg/year. The amount of short-term oral prednisone decreased during the treatment Mean daily dose of inhaled beclomethasone was 2861 mu g/day, decreasing during treatment Morning plasma cortisol was normal in all patients before and after stimulation (163 +/- 44 and 1 +/- 60 mu g/ml respectively), Nolomethasone dose and plasma cortisol level before or after stimulation. DISCUSSION: The high dose of inhaled bedomethasone used to treat nasal polyposis does not affect the HPA axis. Some authors in the literature contest the validity of short synacthen test to detect HPA axis suppression. This test does however detect severe impairments of the HPA axis in outpatients.