Cardiomyopathies and Adrenal Diseases

Abstract

Cardiomyopathies are myocardial disorders in which heart muscle is structurally and/or functionally abnormal. Previously, structural cardiomyocyte disorders due to adrenal diseases, such as hyperaldosteronism, hypercortisolism, and hypercatecholaminism, were misunderstood, and endomyocardial biopsy (EMB) was not performed because was considered dangerous and too invasive. Recent data confirm that, if performed in experienced centers, EMB is a safe technique and gives precious information about physiopathological processes implied in clinical abnormalities in patients with different systemic disturbances. In this review, we illustrate the most important features in patients affected by primary aldosteronism (PA), Cushing’s syndrome (CS), and pheochromocytoma (PHEO). Then, we critically describe microscopic and ultrastructural aspects that have emerged from the newest EMB studies. In PA, the autonomous hypersecretion of aldosterone induces the alteration of ion and water homeostasis, intracellular vacuolization, and swelling; interstitial oedema could be a peculiar feature of myocardial toxicity. In CS, cardiomyocyte hypertrophy and myofibrillolysis could be related to higher expression of atrogin-1. Finally, in PHEO, the hypercontraction of myofilaments with the formation of contraction bands and occasional cellular necrosis has been observed. We expect to clear the role of EMB in patients with cardiomyopathies and adrenal disease, and we believe EMB is a valid tool to implement new management and therapies.

Cushing Syndrome Associated Myopathy: It Is Time for a Change

“…The direct effects of prolonged hypercortisolism on the myocardium are poorly understood [ 40 , 49 ]. Myocardial biopsies from patients with CS indicate myocardial hypertrophy, fibrosis, and myofibrillolysis [ 50 ]. The increased expression of atrogin-1, a marker of muscle atrophy, was observed [ 51 , 52 ].…”

Analysis of the miRNA expression from the adipose tissue surrounding the adrenal neoplasia

“…In addition to the development of moderate–severe hypertension and RH, PA is associated with important target organ damage and the development of several complications related to pressure overload and to pleiotropic effects of aldosterone on the CV system; moreover, PA is characterized by several metabolic changes, such as metabolic syndrome ( 40 ), cardiac fibrosis ( 48 ), myocardial hypertrophy ( 4 , 49 ), arrhythmias, HF, and deleterious effects on vascular remodeling, such as endothelial dysfunction, and oxidative stress, perivascular inflammatory lesions, fibrosis, platelets activation, and renal function ( 3 , 5 – 7 ).…”

“…Primary aldosteronism is characterized by several metabolic changes, such as metabolic syndrome ( 3 ), myocardial hypertrophy and fibrosis ( 4 ), atrial fibrillation ( 5 ), and in particular, heart failure (HF) and deleterious effects on vascular remodeling secondary to endothelial dysfunction ( 6 – 8 ).…”

Cellular and Molecular Mechanism of Traditional Chinese Medicine on Ventricular Remodeling

“…Ang II can induce ET-1 by ROS and ERK ( 78 , 117 ), and ET-1 can not only contract blood vessels but also induce fibroblasts to produce ECM ( 118 ). Ang II can induce aldosterone production in the adrenal cortex, and aldosterone can induce cardiomyocyte apoptosis and cardiomyocyte hypertrophy by activating oxidative stress and regulating ion channels ( 119 , 120 ). Related research has shown that Ang II can increase the secretion of TNF-α and IL-6 ( 121 ), and the mechanism of their participation in VR was described in the following paragraphs.…”