Clinical relevance of cardiac structure and function abnormalities in patients with Cushing’s syndrome before and after cure

Toja, Paola; Branzi, Giovanna; Ciambellotti, Francesca; Radaelli, Piero; Martin, Martina De; Lonati, Laura; Scacchi, Massimo; Parati, Gianfranco; Cavagnini, Francesco; Giraldi, Francesca Pecori

doi:10.1111/j.1365-2265.2011.04206.x

Cited by 80 publications

(78 citation statements)

References 28 publications

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“…Similarly, in another study performed in 15 patients in remission for at least 5 years, the persistence of visceral obesity, hypertension, impairment of glucose tolerance or diabetes mellitus, and dyslipidemia were found. Thus, patients with CS in remission might have a higher incidence of the metabolic syndrome and vascular disease, due to the persistence of an insulin resistance state and cardiac damage [49,50], but also of psychiatric disorders, compared to the general population [51][52][53].…”

Section: Discussionmentioning

confidence: 99%

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

et al. 2016

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Cushing syndrome (CS) is characterized by increased morbidity and mortality compared to the general population. However, there are patients who have more clinical aggressive forms than others. Aim of the study is to evaluate whether the degree of hypercortisolism, defined by the number of times urinary free cortisol (UFC) levels exceed the upper limit of the normal range (ULN), is related to the worsening of phenotypic features, as well as metabolic and cardiovascular parameters, in a cohort of CS patients. A cross-sectional study was conducted on 192 patients with active CS, consecutively presenting at the outpatients' clinic of the University Hospitals of Ancona, Naples, and Palermo. Patients were grouped into mild (UFC not exceeding twice the ULN), moderate (2-5 times the ULN), and severe (more than 5 times the ULN) hypercortisolism. Thirty-seven patients (19.3 %) had mild, 115 (59.8 %) moderate, and 40 (20.9 %) severe hypercortisolism. A significant trend of increase among the three groups was demonstrated for 8-, 16-, and 24-h serum cortisol levels (p \ 0.001) and serum cortisol after low dose of dexamethasone suppression test (p = 0.001). No significant trend of increase was found regarding phenotype and comorbidities. The degree of hypercortisolism by itself does not appear to be a sufficient parameter to express the severity of CS. Therefore, estimating the severity of CS according to biochemical parameters remains a challenge, while the clinical phenotype and the associated comorbidities might be more useful to assessing the severity of the CS.

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Section: Discussionmentioning

confidence: 99%

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

et al. 2016

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“…Jak wykazali Toya i wsp. i Pareira i wsp., leczenie radykalne ZC i normalizacja poziomu kortyzolu powoduje u więk-szości chorych wycofanie się zmian strukturalnych serca [24,25].…”

Section: Nadciśnienie Tętniczeunclassified

Symptomatology of Cushing’s syndrome

Jonczyk¹

2014

Pediatr. Endocrinol.

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Glikokortykosteroidy, z których kluczową rolę pełni kortyzol, odgrywają wiele istotnych funkcji metabolicznych, przede wszystkim w regulacji stężenia glukozy czy wpływie na przemiany białek i tłuszczów. Zwiększona sekrecja kortyzolu lub jego nieprawidłowy metabolizm albo zwiększona wrażliwość tkanek na działanie glikokortykosteroidów mogą prowadzić do wystąpienia zaburzeń metabolicznych i rozwoju zespołu Cushinga. W artykule omówiono najczęściej występujące objawy tego zespołu oraz patomechanizmy ich powstawania. Pediatr. Endocrinol. 13/2014;1(46):41-54. Glucocorticoids, among which cortisol is the most important factor, have various metabolic functions. They regulate glucose levels and influence proteins and lipids metabolism. Higher secretion of cortisol or abnormal metabolism or increased tissue sensitivity to glucocorticoids might be a source of metabolic disorders and Cushing's syndrome. The article discusses the most common symptoms of the Cushing`s syndrome and the pathomechanisms of their formation. Symptomatologia zespołu Cushinga Symptomatology of Cushing's syndrome Paweł Jonczyk STN przy Zakładzie Patofizjologii Katedry Patofizjologii i Endokrynologii Śląskiego Uniwersytetu Medycznego w Katowicach Adres do korespondencji:Paweł Jonczyk, Pl. Traugutta 2, 41-800 Zabrze, e-mail: pawel_jonczyk@o2.pl Słowa kluczowe: zespół Cushinga, glikokortykosteroidy, kortyzol Key words: Cushing's syndrome, glucocorticoids, cortisol STRESZCZENIE/ABSTRACT WstępGlikokortykosteroidy (GKS) to substancje o charakterze hormonów lipidowych, wydzielane przez korę nadnerczy -głównie jej warstwę pasmowatą (zona fasciculata), w sytuacjach szeroko pojętego "stresu" dla organizmu, zarówno fizycznego, jak i emocjonalnego. Głównymi przedstawicielami GKS są kortyzol i kortykosteron, pochodne cholesterolu.To dzięki nim organizm reguluje liczne procesy fizjologiczne umożliwiające adaptację do stale zmieniają-cych się warunków środowiska.GKS wpływają przede wszystkim za pośred-nictwem specyficznych receptorów wewnątrzko-mórkowych na metabolizm węglowodanów, białek i tłuszczów, na gospodarkę wodno-mineralną, układ sercowo-naczyniowy, metabolizm kości, funkcje układu immunologicznego oraz przekaźnictwo

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“…Especially diastolic dysfunction can be seen in these patients. Although there are a lot of ecocardiographic studies [10][11][12] in functional adrenal incidentalomas (Cushing syndrome, primary hyperaldosteronism, pheochromocytoma) there is not enough research of ecocardiographic studies in nonfunctional adrenal incidentalomas. Because we know that cardiac diseases are increasingly observed in patients with subclinical impairment of left ventricular (LV) diastolic function a precursor to overt heart failure [13].…”

Section: Introductionmentioning

confidence: 99%

Carotid intima-media thickness as the cardiometabolic risk indicator in patients with nonfunctional adrenal mass and metabolic syndrome screening

Akkuş¹,

Tetıker²,

Deniz³

et al. 2016

EJEA

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Background:Our purpose was to show the association of adrenal incidentaloma and metabolic syndrome in consideration of the studies and to detect the increase in the carotid intima-media thickness which is regarded as the precessor of atherosclerosis. Material/Methods:Eighty-one patients who were diagnosed with adrenal mass were included in the study. Hormonal evaluation, insulin rezistance measurement with the HOMA-IR and 1-mg DST were performed of all patients. The patients were classified as follows: mass size <3 cm (K 1 ) and mass size of at least 3 cm (K 2 ). Echocardiography and carotid intima-media thickness of the patients were measured using B-mode ultrasound. Thirty-three healthy individuals were enrolled as the control group. Results:Mass size of 64.19% K 1 , while mass size of the remainder (35.81%) K 2 was calculated. Five of the patients with adrenal mass were detected to have subclinical Cushing syndrome. The remaining 76 patients were accepted as nonfunctional. It was seen with regard to metabolic and biochemical parameters that plasma glucose (p=0.01), insulin (p=0.00) and triglyceride (p=0.012) values of all patients were significantly high compared to those of the control group. It was detected that measured heart rate (p=0.00), end-diastolic diameter (p=0.02), end-systolic diameter (p=0.014) and carotid intima-media thickness (p=0.00) values of the patients with adrenal mass were significantly higher than those of the healthy control group. Conclusions:We found that the increased insulin resistance, increased risk of cardiovascular disease with the increase in the thickness of carotid intima-media and diastolic disfunction parameters, although the patients with adrenal incidentaloma are nonfunctional.

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Clinical relevance of cardiac structure and function abnormalities in patients with Cushing’s syndrome before and after cure

Abstract: Cushing's syndrome is associated with an increased risk for abnormalities of cardiac mass, which ameliorates, but does not fully disappear after remission. Systolic and diastolic functions are largely within the normal range in these patients.

Cited by 80 publications

References 28 publications

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

The degree of urinary hypercortisolism is not correlated with the severity of cushing’s syndrome

Symptomatology of Cushing’s syndrome

Carotid intima-media thickness as the cardiometabolic risk indicator in patients with nonfunctional adrenal mass and metabolic syndrome screening

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