The effect of six weeks topical nasal betamethasone drops on the hypothalamo-pituitary-adrenal axis and bone turnover in patients with nasal polyposis

Abstract

Betamethasone topical nasal drops may have systemic corticosteroid activity and cause suppression of the hypothalamo-pituitary-adrenal (HPA) axis and impairment of bone turnover. The aim of this study was to assess the effect of a standard 6-week regime of betamethasone topical nasal drops on the HPA axis (using a physiological dose (1 microg) ACTH test) and on bone turnover (using markers of bone turnover, urinary deoxypyridinoline and serum bone specific alkaline phosphatase). Eleven patients with nasal polyposis were included in a prospective cohort study. Plasma cortisol was lower after betamethasone treatment at all time intervals (P < 0. 0001). There was no change in urinary deoxypyridinoline corrected for creatinine or bone specific alkaline phosphatase. Six weeks' treatment with recommended doses of betamethasone suppresses the HPA axis, but has no significant effect upon markers of bone turnover. Topical betamethasone in subjects with nasal polyps should be viewed as systemic corticosteroid administration and the long and short-term sequelae should be borne in mind.

Topical intranasal corticosteroids and growth velocity in children: a meta‐analysis

“…Topical intranasal corticosteroids act directly on the nasal mucosa to produce optimal effects, but older trials have shown that dexamethasone, beclomethasone, and betamethasone may induce moderate adrenal suppression . The primary response of corticosteroids on the hypothalamic pituitary axis is negative feedback caused by suppression of corticotrophin‐releasing hormone and adrenocorticotropic hormone levels, resulting in decreased cortisol secretion .…”

The safety and efficacy of short‐term budesonide delivered via mucosal atomization device for chronic rhinosinusitis without nasal polyposis

“…A randomized double‐blind study by Fowler et al., in patients with nasal polyposis, showed suppression of the HPA axis following an 8‐week course of betamethasone drops but a similar length course with fluticasone nasules had no effect. A further study by the same team also showed that 6 weeks of treatment with the recommended dose of intranasal betamethasone drops suppressed the HPA axis . However, beclomethasone dipropionate nasal spray is not associated with any suppressive effect on the HPA axis in both adults and children and does not produce systemic side effects, even with prolonged use of up to 6 years…”

“…Many intranasal steroid preparations have been studied including prednisolone acetate nasal spray, fluticasone propionate spray and nasules, triamcinolone acetonide spray, mometasone furoate spray, fluticasone furoate spray, beclomethasone dipropionate spray, betamethasone nasules, budesonide spray and respules, and budesonide respules added to saline irrigations . Few studies have shown any measurable impact on the HPA axis.…”

Treatment of nasal polyposis and chronic rhinosinusitis with fluticasone propionate nasal drops reduces need for sinus surgery

“…Betamethasone drops have effectively been used for the treatment of nasal polyps, but there was considerable suppression of the hypothalamic-pituitary-adrenal axis. 7 Recently, fluticasone propionate nasal drops (FPNDs), Nasules (GlaxoSmithKline, Brentford, Essex, United Kingdom), have become available for the treatment of polyposis. These have a low bioavailability and fixed dosage volume to achieve controlled administration.…”