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Updated: May 21, 2025
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Published on: January 17, 2018
Effect of budesonide nasal irrigation on Hypothalamic-Pituitary-Adrenal Axis in patients with chronic rhinosinusitis
Jesada Kanjanaumporn1,2, Sorranut Thaweboon1, Songklot Aeumjaturapat1,2
1Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Background:
Corticosteroids added to high volume saline nasal irrigation have been introduced as a more effective method of delivering corticosteroids to the sinuses than nasal sprays. However, information regarding the effect of this intervention on the hypothalamic-pituitary-adrenal (HPA) axis is still limited.
Objective:
To evaluate the safety of long-term corticosteroid (6 months) nasal irrigation in patients with chronic rhinosinusitis (CRS) post endoscopic sinus surgery.
Methods:
Seventeen patients with CRS were included. After undergoing endoscopic sinus surgery, the patients were prescribed budesonide nasal irrigations (250 ml via squeeze bottle) twice daily (1 mg/day) for six months. The serum morning cortisol levels of these patients were then evaluated at 3 and 6 months post-operatively.
Results:
Median serum morning cortisol levels were 10.5 mcg% at pre-operative baseline; 10.3 mcg% at 3 months; and 11.2 mcg% at 6 months on post-operative follow-up. There were no significant changes in the serum morning cortisol levels (P value = 0.71 and 0.63 respectively). Three of 17 patients (17.65%) had mildly abnormal serum morning cortisol levels (4, 4.3 and 4.9 mcg%) at 3 months. However, these levels were within a normal range at 6 months.
Conclusions:
Serum morning cortisol levels were not significantly changed after usage of budesonide nasal irrigation for 6 months.
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