Circadian blood pressure profile in patients with Cushing’s syndrome before and after treatment

Abstract

The aim of the study was to evaluate the circadian blood pressure (BP) profiles in patients with two forms of Cushing's syndrome, and to compare them to those in patients with essential hypertension. The study included 100 patients with Cushing's syndrome (80 with pituitary adenomas and 20 with adrenal adenomas) and 40 with essential hypertension. Twenty-four-h ambulatory BP monitoring was performed before and after therapy. All 3 groups had similar office-, 24-h-, awake-, and sleep BP mean values. The awake-sleep differences between the patients with two forms of Cushing's syndrome were similar. The night-time BP decline in the patients with Cushing's disease, as well as in those with adrenal adenomas, was significantly lower than that in the patients with essential hypertension. In the patients with both forms of Cushing's syndrome, there was a highly significant decline in the office and ambulatory BP levels after the treatment, and the awake-sleep systolic BP difference became significantly higher. The night-time diastolic BP decline was significantly higher after treatment in patients with adrenal adenomas and not-significantly higher in patients with Cushing's disease. In the patients with Cushing's disease, the duration of hypertension was greater, and lower percentage of normalized BP after treatment was observed in comparison with the patients with adrenal adenomas. The significant negative correlation between duration of the disease and extent of the night-time BP decline suggests that the 'non-dipping' profile is related not only to hypercortisolism itself but also to the severity of hypertension and duration of the disease.

A Critical Role for Vascular Smooth Muscle in Acute Glucocorticoid-Induced Hypertension

“…Consistent with previous reports, DEX induced a dramatic blunting of normal diurnal variation of BP in control mice. 17,18 Interestingly, similar effects were noted in the Sm-22 Creϩ GR loxP/loxP mice as well. Both groups showed a similar degree of deranged diurnal variation of BP for the entire time DEX was administered.…”

“…Patients with disordered cortisol secretion, such as those with Cushing syndrome, commonly lose their diurnal BP variation. 18 Our data indicate that GR in VSM plays a critical role in the acute response of BP to systemic GC. The absence of a noticeable effect of VSM GR deletion on circadian BP variation in our mice indicates that this acute effect of GC on VSM tone is not necessary for normal circadian BP variation.…”

“…GC have previously been implicated as having a primary role in the diurnal variation of BP. 17,18 We questioned whether VSM GR might play an important role in normal circadian variation of BP, and we therefore assessed peak/nadir BP in our Sm-22 Creϩ GR loxP/loxP mice. As seen in Table 1, we observed a similar circadian variation BP pattern in Sm-22 Creϩ GR loxP/loxP and control mice.…”

The current state of knowledge about the dipping and non-dipping hypertension

“…Impairment of the circadian BP rhythm has been reported in patients with Cushing's syndrome and pheochromocytoma [93,99,100]. Investigation by Krzyzanowska et al revealed a correlation between hypopituitarism occurrence and abnormal circadian BP [101].…”

cAMP signaling in cortisol-producing adrenal adenoma

“…The classic clinical picture of a patient affected by Cushing's syndrome is characterized by easy bruising, facial plethora, proximal muscle weakness, striae rubrae, and hirsutism (Table 1) (13). In addition, hypertension is a very common feature of the syndrome, occurring in 80% of the patients, and is characterized by drug resistance in up to 17% of cases, as well as by loss of nocturnal dipping (14,15,16). Alterations of glucose and lipid metabolism are also common findings in patients with Cushing's syndrome.…”