Safety of methylprednisolone irrigation during sialendoscopy: effects on the hypothalamic-pituitary-adrenal axis

To assess the safety of methylprednisolone irrigation in the ductal system of salivary glands during sialendoscopy and its impact on the hypothalamic-pituitary-adrenal (HPA) axis.

Nineteen patients with non-lithiasic sialadenitis were included. Sialendoscopy was performed on the most affected gland (11 parotid, 8 submandibular glands), with 60 mg of methylprednisolone in a 5 ml solution of 0.9% NaCl saline irrigated into the ductal system. Serum cortisol and methylprednisolone concentrations were measured before irrigation, at 2 and 24 h (h) post-irrigation. Patients were examined for post-interventional symptoms and signs 24 h later.

Serum cortisol concentrations increased at 2 h (p < 0.05), followed by a decrease (p < 0.01) at 24 h. Decrease was recorded in serum cortisol from 0 h to 24 h (17.2 ± 5.9 vs. 9.2 ± 8.0 µg/dl, respectively, p < 0.01); 37% of patients fulfilled the criteria for HPA axis suppression (serum cortisol ≤ 1.8 µg/dl). A similar pattern for serum cortisol was observed for the parotid and submandibular glands separately, with more pronounced decrease in the parotid. Serum methylprednisolone increased at 2 h, followed by a decrease to minimal concentrations at 24 h. Pain during methylprednisolone irrigation was reported in 57.9% of patients. Blood pressure and glucose concentrations remained unaffected, and no other symptoms were reported.

Methylprednisolone irrigation during sialendoscopy caused biochemical HPA axis suppression in 37% of patients after 24 h. However, the procedure is considered safe, as there were no reported cases of clinical hypocortisolemia. The decrease in serum cortisol at 24 h was observed mainly after parotid gland irrigation. Minimal drug concentrations were found in the serum after 24 h.