title: Effect of intranasal dexamethasone on endogenous cortisol level and intraocular pressure.
abstract: BACKGROUND
  Medical treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) centers on the administration of steroids. High-dose topical nasal steroids (HDTNS) have shown promising results with less systemic effects than oral steroids. One promising HDTNS is 0.132% dexamethasone nasal spray. We investigated whether intranasal dexamethasone was associated with changes in serum cortisol and/or intraocular pressure (IOP).
  
  
  METHODS
  Patients with CRSwNP were treated with dexamethasone sodium phosphate 0.132% nasal spray twice daily. Morning serum cortisol and IOP were checked after at least 6 weeks of therapy.
  
  
  RESULTS
  Twenty-eight patients met study criteria. The average serum cortisol level after at least 6 weeks of therapy (average duration of 38.3 weeks) was 9.8 μg/dL (normal range, 4 to 22 μg/dL). Ten patients had suppressed cortisol levels (average, 2.5 μg/dL). Ten patients underwent IOP measurements and none revealed ocular hypertension on tonometry.
  
  
  CONCLUSIONS
  High-dose dexamethasone nasal spray given for a period of at least 6 weeks does appear to have the potential to cause a decrease in serum cortisol levels; however, future studies with greater power are necessary to support this claim. Additionally, similar administration of high-dose dexamethasone nasal spray did not reveal IOP diagnostic of ocular hypertension on single-measurement tonometry readings.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Martino
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Church
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Seiberling
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000097:blood / Q000188:drug therapy*; D059085:Nasal Sprays; D012189:Retrospective Studies; D012220:Rhinitis / Q000097:blood / Q000188:drug therapy*; D012852:Sinusitis / Q000097:blood / Q000188:drug therapy*; D014065:Tonometry, Ocular; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D059085:Nasal Sprays; D003907:Dexamethasone; D006854:Hydrocortisone
keywords: chronic rhinosinusitis; intranasal dexamethasone; intranasal steroids; intraocular hypertension; nasal polyps; serum cortisol