title: The effects of serum and urinary cortisol levels of topical intranasal irrigations with budesonide added to saline in patients with recurrent polyposis after endoscopic sinus surgery.
abstract: BACKGROUND
  The delivery of topical intranasal corticosteroid sprays has traditionally been the primary method of treating recurrent nasal polyposis. An emerging treatment for polyposis is budesonide nasal irrigations. Delivered at concentrations nearly 100 times greater than found in prescription nasal sprays, there have been little studies on the effects of budesonide irrigation on the adrenal axis. Therefore, we investigated whether irrigation with budesonide solution was associated with any increase in serum cortisol and 24-hour urinary cortisol levels.
  
  
  METHODS
  Patients who previously had undergone endoscopic sinus surgery and were not taking prednisone for 3 months were prospectively enrolled in this study. Patients irrigated twice daily with 0.5 mg/2 mL of budesonide mixed with 240 mL of saline solution. Serum cortisol and 24-hour urinary cortisol were collected before drug administration and 6 weeks after continuous use.
  
  
  RESULTS
  Ten patients completed this study. The average serum cortisol and 24-hour urinary cortisol before drug administration were 9.8 +/- 5.4 microg/dL and 28.1 +/- 15.1 microg/24 hours, respectively. After 6-week follow-up, the average serum cortisol and 24-hour urinary cortisol were 12.8 +/- 3.5 microg/dL and 16.5 +/- 5.6 microg/24 hours, respectively. Normal ranges for serum cortisol and 24-hour urinary cortisol are 5-25 microg/dL and 4-50 microg/24 hours, respectively.
  
  
  CONCLUSIONS
  Irrigation with budesonide, 0.5 mg/2 mL, in 250 mL of saline solution does not result in decreases of serum cortisol and 24-hour urinary cortisol levels. Based on this, we feel irrigation with budesonide solution is safe to perform in patients as an alternative to traditional aerosolized steroid sprays or systemic corticosteroids.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA. kwelch1@lumc.edu
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Welch
authors.forename: Erica R
authors.initials: ER
authors.lastname: Thaler
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Doghramji
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019819:Budesonide / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease; D004724:Endoscopy; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000652:urine*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D008875:Middle Aged; D009298:Nasal Polyps; D010913:Pituitary-Adrenal System / Q000187:drug effects; D011446:Prospective Studies; D012008:Recurrence; D012220:Rhinitis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery / Q000652:urine; D012852:Sinusitis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery / Q000652:urine; D007507:Therapeutic Irrigation
chemical_list: D019819:Budesonide; D006854:Hydrocortisone