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

OBJECTIVE: To assess the hypothalamic-pituitary-adrenal (HPA) axis after lo ng-term intranasal corticosteroid treatment in nasal polyposis. PATIENTS AND METHODS: A short synacthen test was performed in 24 patients w ho received the highest dose of inhaled beclomethasone among a population o f 392 patients treated for nasal polyposis with inhaled corticosteroid ther apy and short-term oral corticosteroids. RESULTS: Mean yearly dose of oral prednisone administered in shortterm trea tment was 371 mg/year. The amount of short-term oral prednisone decreased d uring 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 res pectively), Nolomethasone dose and plasma cortisol level before or after st imulation. DISCUSSION: The high dose of inhaled bedomethasone used to treat nasal poly posis does not affect the HPA axis. Some authors in the literature contest the validity of short synacthen test to detect HPA axis suppression. This t est does however detect severe impairments of the HPA axis in outpatients.