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Sialendoscopy was performed on the most affected gland (11 parotid, 8 submandibular glands), with 60\u00a0mg of methylprednisolone in a 5\u00a0ml solution of 0.9% NaCl saline irrigated into the ductal system. Serum cortisol and methylprednisolone concentrations were measured before irrigation, at 2 and 24\u00a0h (h) post-irrigation. Patients were examined for post-interventional symptoms and signs 24\u00a0h later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Serum cortisol concentrations increased at 2\u00a0h (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), followed by a decrease (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) at 24\u00a0h. Decrease was recorded in serum cortisol from 0\u00a0h to 24\u00a0h (17.2\u2009\u00b1\u20095.9 vs. 9.2\u2009\u00b1\u20098.0\u00a0\u00b5g\/dl, respectively,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01); 37% of patients fulfilled the criteria for HPA axis suppression (serum cortisol\u2009\u2264\u20091.8\u00a0\u00b5g\/dl). A similar pattern for serum cortisol was observed for the parotid and submandibular glands separately, with more pronounced decrease in the parotid. Serum methylprednisolone increased at 2\u00a0h, followed by a decrease to minimal concentrations at 24\u00a0h. Pain during methylprednisolone irrigation was reported in 57.9% of patients. Blood pressure and glucose concentrations remained unaffected, and no other symptoms were reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Methylprednisolone irrigation during sialendoscopy caused biochemical HPA axis suppression in 37% of patients after 24\u00a0h. However, the procedure is considered safe, as there were no reported cases of clinical hypocortisolemia. The decrease in serum cortisol at 24\u00a0h was observed mainly after parotid gland irrigation. Minimal drug concentrations were found in the serum after 24\u00a0h.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00405-025-09678-1","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T19:44:45Z","timestamp":1758656685000},"page":"5919-5927","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Safety of methylprednisolone irrigation during sialendoscopy: effects on the hypothalamic-pituitary-adrenal axis"],"prefix":"10.1007","volume":"282","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3905-5650","authenticated-orcid":false,"given":"Konstantinos","family":"Garefis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelos","family":"Chatziavramidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5005-1995","authenticated-orcid":false,"given":"Dimitrios","family":"Goulis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Nikolaidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9891-5185","authenticated-orcid":false,"given":"Konstantinos","family":"Markou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9244-464X","authenticated-orcid":false,"given":"Iordanis","family":"Konstantinidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"issue":"5","key":"9678_CR1","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1177\/0145561319841207","volume":"98","author":"SJ Lele","year":"2019","unstructured":"Lele SJ, Hamiter M, Fourrier TL, Nathan CA (2019) Sialendoscopy with intraductal steroid irrigation in patients with sialadenitis without sialoliths. 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