{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T14:23:31Z","timestamp":1747146211110,"version":"3.40.5"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,9,26]],"date-time":"2021-09-26T00:00:00Z","timestamp":1632614400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Medically refractory chronic rhinosinusitis (CRS) is often treated with functional endoscopic sinus surgery (FESS) and high\u2010volume steroid nasal irrigation. While budesonide is the most common steroid irrigation for this indication, mometasone has a superior pharmacokinetic profile, which may allow dose escalation. The safety and efficacy of mometasone at higher concentrations than previously used in treating CRS have not been explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were recruited from a tertiary level clinic between June 2018 and December 2019. Inclusion criteria included adults (&gt;18 years); CRS diagnosis; previous FESS; pre\u2010treatment morning cortisol within normal range; minimum of twice daily high\u2010volume sinonasal mometasone irrigations (total dose of 4 mg) for 12 weeks; and post\u2010treatment morning cortisol measured within 2 weeks following the study period. Patients with potential for endogenous or exogenous disruption of the HPA axis were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>14 patients were enrolled in this prospective cohort study. In all but one patient, pre\u2010 and post\u2010treatment morning cortisol levels were not significantly different and were within normal limits (6.7\u201025.4 \u03bcg\/dL). Following an uninterrupted 12\u2010week treatment course, no evidence of HPA axis suppression was found (<jats:italic>P = 0.915<\/jats:italic>). The single patient who was found to have a low (1.3 \u03bcg\/dL) post\u2010treatment morning serum cortisol level reportedly received an intraarticular steroid shot several days prior to the blood draw. She remained asymptomatic and her rechecked serum cortisol was within normal limits at 12.3 \u03bcg\/dL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>High\u2010volume 2 mg twice daily sinonasal mometasone irrigations did not cause HPA axis suppression in a representative sample of patients with refractory CRS post\u2010FESS with normal baseline cortisol levels.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22894","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T04:30:04Z","timestamp":1632717004000},"page":"249-256","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The possibility of short\u2010term hypothalamic\u2010pituitary\u2010adrenal axis suppression with high\u2010volume, high\u2010dose nasal mometasone irrigation in postsurgical patients with chronic rhinosinusitis"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1188-6858","authenticated-orcid":false,"given":"Hannah J.","family":"Brown","sequence":"first","affiliation":[{"name":"Rush Medical College Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pete S.","family":"Batra","sequence":"additional","affiliation":[{"name":"Rush Sinus Program, Department of Otorhinolaryngology \u2013 Head and Neck Surgery Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Eggerstedt","sequence":"additional","affiliation":[{"name":"Rush Sinus Program, Department of Otorhinolaryngology \u2013 Head and Neck Surgery Rush University Medical Center  Chicago Illinois 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