Incidence of hypocortisolism with long-term budesonide irrigations for chronic rhinosinusitis. International forum of allergy & rhinology Silva, B. R., Tyler, M. A., Ma, Y., Wang, J., Nayak, J. V., Patel, Z. M., Hwang, P. H. 2023


Budesonide irrigations (BI) are commonly used to control inflammation in chronic rhinosinusitis (CRS). In 2016 we reported an analysis of long-term budesonide irrigation with regard to hypothalamic-pituitary-adrenal axis function. We present a follow-up analysis in a larger cohort of patients with longer follow-up.Patients were candidates for stimulated cortisol testing after regularly performing BI for CRS at least daily for = 6 months. We retrospectively evaluated all patients who received stimulated cortisol testing at our center between 2012-22. We correlated cortisol levels with use of BI and other forms of corticosteroids.We analyzed 401 cortisol test results in 285 patients. The mean duration of use was 34 months. Overall, 21.8% of patients were hypocortisolemic (<18 ug/dL) at first test. In patients who used only BI the rate of hypocortisolemia was 7.5%, whereas in patients who also used concurrent oral and inhaled corticosteroids, the rate was 40-50%. Lower cortisol levels were associated with male gender (p<.0001) and concomitant use of oral and inhaled steroids (p<.0001). Duration of budesonide irrigation use was not significantly associated with lower cortisol levels (p = 0.701), nor was greater dosing frequency (p = 0.289).Prolonged use of BI alone is not likely to cause hypocortisolemia in the majority of patients. However, concomitant use of inhaled and oral steroids, and male gender may be associated with hypocortisolemia. Surveillance of cortisol levels may be considered in vulnerable populations who use budesonide irrigations regularly, particularly in patients using other forms of corticosteroids with known systemic absorption. This article is protected by copyright. All rights reserved.

View details for DOI 10.1002/alr.23227

View details for PubMedID 37389470