Glucocorticoid-induced cardiomyopathy: unexpected conclusion

Abstract

Glucocorticoid excess is an under-recognised cause of cardiovascular adverse effects. The sources can be either endogenous (Cushing’s syndrome) or exogenous (Anabolic steroid abuse). Cardiovascular complications due to excess glucocorticoid includes hypertension, left ventricular hypertrophy, myocardial infarction, and heart failure. Although anabolic steroid-induced cardiomyopathy is a well-recognised phenomenon, endogenous corticosteroid-induced cardiomyopathy and heart failure are rarely reported sequelae of glucocorticoid excess in the body. We report a glucocorticoid-induced dilated cardiomyopathy in a 26-year-old African–American man with cushingoid features and symptomatic heart failure.

Glucocorticoid-Induced Cardiomyopathy Caused by Uncontrollable Asthma

“…Our search of the relevant literature identified no reports of dilated cardiomyopathy due to glucocorticoid overdose, but there are a few reports of cardiomyopathy induced by Cushing's syndrome. Sheikh et al described a case of cardiomyopathy secondary to Cushing's disease due to a pituitary adenoma [ 6 ]. Diuretic therapy and endocrinology have improved the patient’s left ventricular systolic dysfunction.…”

A Suggestion for Proactive Cardiologic Approach to Cushing’s Syndrome or Disease

“…It is particularly so if hypercortisolism is not controlled. Even following the effective therapy of CD (despite a decrease of BP and body mass index) the majority Reference confirming the rationale for the cited drug (or diagnostic procedure) for particular co-morbidity /characteristic HTN (early treatment) [5,6] RAAS blocker, spironolactone, consider timely (using ABPM) CCB, diuretic and BB [15,16] Hyperlipidemia (early treatment) [5] depending upon FHS or SCORE, consider statin [20][21][22] HF (primary prevention) [5,23] RAAS blocker, spironolactone [24,25] CAD (early diagnosis) [5,26,27] Pretest probability of CAD, ECG, exercise test, CT calcium score [28,29] CAD (primary prevention) [5,26,30] Consider aspirin and statin [29,31] Hypokalemia (early treatment) [32] spironolactone, RAAS blocker [33,34] VTE (early diagnosis) [35] Clinical prediction rule, D dimer, venous ultrasound [36,37] Legend: CS/CD -Cushing's syndrome/Cushing's disease; HTNarterial hypertension; RAASrenin-angiotensin-aldosterone system; ABPMambulatory blood pressure monitoring; CCB -calcium channel blocker; BBbeta-blocker; FHS -Framingham Risk Score; SCORE -Systematic COronary Risk Evaluation; HFheart failure; CADcoronary artery disease; CTcomputerized tomography; ECGelectrocardiogram.…”

“…The most important risk factors of HF are clustered in CS/CD, such as HTN, CAD, obesity, and DM [5]. Moreover, a direct effect of glucocorticoid excess upon cardiomyocytes is probable [23,[47][48][49]]. An echocardiogram is needed in CS/CD patients to evaluate the presence of structural and functional abnormalities of the heart, which are common in CS/CD patients, starting from left ventricular hypertrophy (LVH) as a result of several aforementioned risk factors.…”

Side effects of chronic systemic glucocorticoid therapy: what dermatologists should know

“…In the long term, they induce asymmetrical thickening of the left ventricular wall and the diagnosis of heart failure. 25 …”