Adrenal suppression and osteoporosis after treatment of nasal polyposis

Patients with severe nasal polyposis (NP) and a high steroid consumption have a high prevalence of glucocorticoid-induced osteoporosis and secondary adrenal insufficiency.

To evaluate the risk of complications of the medical treatment in patients presenting with the diagnosis of NP.

This was a prospective study. A total of 46 consecutive patients with NP were included when the oral steroid consumption during the past year was greater than three short courses of systemic steroid treatment (i.e. more than 21 days per year of treatment, prednisolone 1 mg/kg body weight per day, for 6-10 days). The nasal function was checked on the basis of five criteria: nasal obstruction, anterior rhinorrhea, posterior rhinorrhea, facial pain, and loss of sense of smell. Two tests were carried out for each patient: (i) a bone mineral density evaluation by dual energy X-ray absorptiometry (DXA) at three different sites in the lumbar spine and femur, and (ii) an evaluation of the hypothalamic-pituitary-adrenal (HPA) axis by the synacthen test.

Most of the patients had a severe NP associated with asthma (78.3% of the population), and aspirin idiosyncrasy (28.3%). In all, 10.9% and 43.5% of patients had osteoporosis and osteopenia at the lumbar spine site. Twenty patients (48.8% of the tested patients) had an asymptomatic adrenal insufficiency.