Endocrine Abstracts

Patients with chronic sinusitis with polyps are prepared for surgery (FESS) in one of two ways: through intranasal steroid therapy or oral preparation. The high-dose oral glucocorticoids are not often used in Poland, because of the due to the risk of developing side effects including pituitary-adrenal axis inhibition with the need for steroid cover during surgery. The 30 patients before FESS were randomly divided into two equal-sized groups. Patients in the first group received intranasal fluticasone propionate at a dose of 800 μg /day for 8 consecutive weeks before surgery. Patients in the second group received oral prednisone at a dose of 0.5 mg/kg/day for 7 days. The degree of polyposis assessed by sinus CT decreased statistically significantly only after treatment with oral steroid (13.14 (95%CI 8.95-15.92) vs. 8.0 (95%CI 4.05-10.59) P=0.000012 on a Lund-Mackay scale). There was no statistically significant difference in ACTH levels (14,73 (95%CI 11,85-19,49) vs. 21,09 (95%CI 12,28-41,08) and in morning cortisol levels before and after oral steroid treatment 1.41 (95%CI 8.44-14.20) vs. 8.16 (95%CI 6.69-14.2) P=0.39) and this effect did not differ from that observed after intranasal therapy. Electrolytes, glucose, and insulin levels also did not change significantly after this treatment. The operation was performed without hydrocortisone cover and no complications were observed. In conclusion, we have stated that our data confirmed the lack of inhibition of the pituitary-adrenal axis after short-term high-doses GCS therapy. We are planning further research in this area with the goal of introducing oral GCS into the standard preparation for FESS.