Adrenal suppression and osteoporosis after treatment of nasal polyposis

Conclusion. Patients with severe nasal polyposis ( NP) and a high steroid consumption have a high prevalence of glucocorticoid- induced osteoporosis and secondary adrenal insufficiency. Objectives. To evaluate the risk of complications of the medical treatment in patients presenting with the diagnosis of NP. Patients and methods. This was a prospective study. A total of 46 consecutive patients with NP were included when the oral steroid consumption during the past year was greater than three short courses of systemic steroid treatment ( i. e. more than 21 days per year of treatment, prednisolone 1 mg/ kg body weight per day, for 6 - 10 days). The nasal function was checked on the basis of five criteria: nasal obstruction, anterior rhinorrhea, posterior rhinorrhea, facial pain, and loss of sense of smell. Two tests were carried out for each patient: ( i) a bone mineral density evaluation by dual energy X- ray absorptiometry ( DXA) at three different sites in the lumbar spine and femur, and ( ii) an evaluation of the hypothalamic- pituitary- adrenal ( HPA) axis by the synacthen test. Results. Most of the patients had a severe NP associated with asthma ( 78.3% of the population), and aspirin idiosyncrasy ( 28.3%). In all, 10.9% and 43.5% of patients had osteoporosis and osteopenia at the lumbar spine site. Twenty patients ( 48.8% of the tested patients) had an asymptomatic adrenal insufficiency.