The effect of six weeks topical nasal betamethasone drops on the hypothalamo-pituitary-adrenal axis and bone turnover in patients with nasal polyposis

Betamethasone topical nasal drops may have systemic corticosteroid activity and cause suppression of the hypothalamo-pituitary-adrenal (HPA) axis and impairment of bone turnover. The aim of this study was to assess the effect of a standard 6-week regime of betamethasone topical nasal drops on the HP A axis (using a physiological dose (1 mu g) ACTH test) and on bone turnover (using markers of bone turnover, urinary deoxypyridinoline and serum bone specific alkaline phosphatase). Eleven patients with nasal polyposis were i ncluded in a prospective cohort study. Plasma cortisol was lower after beta methasone treatment at all time intervals (P < 0.0001). There was no change in urinary deoxypyridinoline corrected for creatinine or bone specific alk aline phosphatase. Six weeks' treatment with recommended doses of betametha sone suppresses the HPA axis, but has no significant effect upon markers of bone turnover. Topical betamethasone in subjects with nasal polyps should be viewed as systemic corticosteroid administration and the long and short- term sequelae should be borne in mind.