title: Preliminary results of a pilot study investigating the potential of salivary cortisol measurements to detect occult adrenal suppression secondary to steroid nose drops.
abstract: Adrenocortical suppression is a well-known risk of systemic steroids, but is thought less likely to occur with topical intranasal corticosteroids. However, the UK Committee on the Safety of Medicines (UKCSM) has expressed concern about the possibility of this complication. We assessed the prevalence of adrenal suppression in patients with rhinitis using intranasal beclomethasone and betamethasone; and the potential value of salivary cortisol as a tool for detecting this complication. Sixty-six patients (38 men: 28 women; mean age 49.6[SD 16.0] years) were prospectively screened for adrenal insufficiency using clinical assessment and salivary cortisol measurements. Abnormalities at this initial screening were confirmed with a Short Synacthen Test (SST). No patient was clinically Cushingoid. All 22 beclomethasone users had normal salivary cortisols. Eleven (25%) of 44 patients using betamethasone had subnormal salivary cortisol levels (mean morning cortisol 2.8[SD 0.9]nmol/l) suggesting adrenal suppression, which was confirmed by an impaired SST in each case. The positive predictive value of salivary cortisol measurements was 100%. Only patients with abnormal salivary cortisols had a SST, so no comment can be made about sensitivity/specificity. Topical betamethasone may produce occult adrenal insufficiency and assessment of adrenal function is recommended in these patients. Measurement of salivary cortisol is a useful, non-invasive and economical test for monitoring patients using intranasal corticosteroids.
authors: Glasgow Royal Infirmary University NHS Trust and Royal Alexandria Hospital, Glasgow, UK. dr_rajan_patel@hotmail.com
authors: R S
authors: RS
authors: Patel
authors: A M
authors: AM
authors: Wallace
authors: J
authors: J
authors: Hinnie
authors: G W
authors: GW
authors: McGarry
mesh_terms: D000281:Administration, Intranasal; D000311:Adrenal Glands / Q000187:drug effects*; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis*; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001507:Beclomethasone / Q000008:administration & dosage* / Q000009:adverse effects; D001623:Betamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012220:Rhinitis / Q000188:drug therapy; D012463:Saliva / Q000737:chemistry*; D012680:Sensitivity and Specificity
chemical_list: D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D001623:Betamethasone; D001507:Beclomethasone; D006854:Hydrocortisone