U. Knutsson et al., EFFECTS OF INTRANASAL GLUCOCORTICOIDS ON ENDOGENOUS GLUCOCORTICOID PERIPHERAL AND CENTRAL FUNCTION, Journal of Endocrinology, 144(2), 1995, pp. 301-310
Glucocorticoids are among the most potent antiinflammatory agents that
can be used in the treatment of rhinitis. Their mechanisms of action
are multiple and complex and a number of reports describe significant
systemic effects of locally administered glucocorticoids. In order to
evaluate the short-term systemic effects of intranasally administered
glucocorticoids, 14 normal healthy subjects were treated with two dose
s of either budesonide (BUD) or fluticasone propionate (FP) for 2 week
s. Before treatment, at regular intervals during the treatment, 1 week
and finally 6 weeks after termination of treatment, the effects on gl
ucocorticoid receptor (GR) and methallothionein (MTIIa) mRNA expressio
n levels were examined in peripheral lymphocytes using a solution hybr
idization assay. Serum cortisol, osteocalcin and urinary cortisol leve
ls were also determined. An insulin tolerance test (ITT) was performed
at the end of the second week of treatment and at the end of the 6-we
ek washout period with no statistically significant change in cortisol
response. In peripheral lymphocytes, GR mRNA levels were significantl
y down-regulated. MTIIa mRNA levels increased significantly. Serum ost
eocalcin decreased significantly during treatment with both BUD and FP
. Serum cortisol decreased after 1 week of treatment whereas urinary c
ortisol was not affected until the second week of treatment. In conclu
sion, intranasal glucocorticoids at clinically recommended doses have
not only significant systemic effects on adrenal function, but also ha
ve an effect on specific gene expression in peripheral lymphocytes. Th
ese effects are receptor-dependent, reversible, and according to serum
and urinary cortisol levels and ITT, leave the hypothalamic-pituitary
-adrenal function intact. Finally, these shea-term systemic effects we
re not associated with any of the noticeable side-effects usually obse
rved during long-term treatment with glucocorticoids.