Diagnosis and management of hypertension in patients with Cushing's syndrome: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension

Abstract

Endogenous/exogenous Cushing's syndrome is characterized by a cluster of systemic manifestations of hypercortisolism, which cause increased cardiovascular risk. Its biological basis is glucocorticoid excess, acting on various pathogenic processes inducing cardiovascular damage. Hypertension is a common feature in Cushing's syndrome and may persist after normalizing hormone excess and discontinuing steroid therapy. In endogenous Cushing's syndrome, the earlier the diagnosis the sooner management can be employed to offset the deleterious effects of excess cortisol. Such management includes combined treatments directed against the underlying cause and tailored antihypertensive drugs aimed at controlling the consequences of glucocorticoid excess. Experts on endocrine hypertension and members of the Working Group on Endocrine Hypertension of the European Society of Hypertension (ESH) prepared this Consensus document, which summarizes the current knowledge in epidemiology, genetics, diagnosis, and treatment of hypertension in Cushing's syndrome.

A unique gene expression signature in visceral adipose tissue identifies a high blood pressure group in patients with Cushing’s syndrome

“…A major challenge in patients with CS is the management of blood pressure [5, 53]. More so it was intriguing that we saw strong effects on endothelia cells and smooth muscle cell abundance, as well as important genes for the vascular system like Vegfa (VEGFA) and VWF (VWF).…”

“…Moreover, patients with CS showed an increased pressor response to angiotensin II [64, 65], and there is evidence that glucocorticoids increase angiotensin II type 1 receptor gene expression [66, 67]. Due to the observed generalized upregulation of the RAS in patients with CS, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are recommended as first-line approach for blood pressure control in CS [5].…”

“…Up to 85% of patients with CS have hypertension at diagnosis, and 9% may require hospital admission because of hypertensive crisis [5]. Prevalence of hypertension depends on subtype, duration of hypercortisolism, age, and co-existing metabolic comorbidities, such as diabetes mellitus, obesity and other components of the metabolic syndrome [6][7][8].…”

Localization diagnosis of adrenocorticotrophic hormone-dependent Cushing’s syndrome: two case reports and literature review

“…For young patients with hypertension or osteoporosis, women with acne, hirsutism and irregular menstruation, and patients with full moon face, buffalo back, facial plethora, purple striae, thin skin, muscle weakness and other signs, it is recommended to complete the screening of CS to make a clear diagnosis (31,32). In a consensus on the diagnosis and treatment of hypertension in patients with CS published this year, it is suggested to screen CS in the following hypertensive populations: patients under 40 years old with grade 2 hypertension, patients with childhood onset hypertension, refractory hypertension, patients with previously chronic stable hypertension presenting with acute exacerbation of blood pressure, hypertension with adrenal lesions, and hypertension with clinical features specific for hypercortisolism (33). Some authors investigated 18 key symptoms of CS in CS patients and non-CS patients, and 5 of them were more common in CS patients than those excluding CS: osteoporosis incompatible with age, adrenal incidentaloma, metabolic syndrome, myopathy, and multiple symptoms such as hypertension, diabetes, and sleep disorders.…”

“…If the blood pressure is still greater than 130/80 mmHg, calcium channel blockers can be added. If the blood pressure is still not up to standard, mineralocorticoid receptor antagonists can be added (33). After active and effective preoperative management, the general conditions of the two patients were significantly improved and received surgical treatment.…”