Complications of Short-Course Oral Corticosteroids for Eosinophilic Chronic Rhinosinusitis during Long-Term Follow-Up

Abstract

The literature strongly recommends the use of oral corticosteroids in the management of patients with eosinophilic chronic rhinosinusitis (CRS) with nasal polyps. Although potential complications associated with the long-term use of oral corticosteroids for the treatment of CRS have been suggested, no studies have described these effects in detail. Forty-three patients with a mean age of 51 years with eosinophilic CRS were retrospectively evaluated after surgery. Short-course oral prednisolone (PSL, 0.5 mg/kg of body weight) was provided for one week when anosmia and eosinophilic mucin and/or nasal polyps were present. The postoperative follow-up period ranged from 12 to 108 months (average: 62 months). HbA1C showed normal ranges in all except one patient, who had a diabetic pattern of HbA1C of 6.5%. Five patients had serum cortisol levels below the cutoff value. However, re-examination of the serum cortisol and adrenocorticotropic hormone stimulation test showed normal ranges in all five patients who had initially shown abnormal values of serum cortisol. Thus, adrenal insufficiency in all the patients was negligible. Five (3 women and 2 men) out of the 15 patients (6 women and 9 men) who participated in bone mineral density measurement showed significant reductions, suggesting the presence of osteoporosis. Patients taking long-term and repeated short-course use of oral corticosteroids for refractory nasal polyps of eosinophilic CRS are likely to have a potentially increased risk for osteoporosis.