Patients with Cushing’s Syndrome Have Increased Intimal Media Thickness at Different Vascular Levels: Comparison with a Population Matched for Similar Cardiovascular Risk Factors

Albiger, Nora; Testa, Roberto; Almoto, B.; Ferrari, Michel; Bilora, Franca; Petrobelli, Francesco; Pagnan, Antonio; Mantero, Franco; Scaroni, Carla

doi:10.1055/s-2006-944545

Cited by 62 publications

(46 citation statements)

References 22 publications

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“…The results of these studies also suggested that beyond a direct effect of glucocorticoid excess on the vascular system, metabolic syndrome may play a pivotal role in carotid atherosclerosis associated with CS. Similar findings were reported also by others [18].…”

Section: Discussionsupporting

confidence: 93%

The relationship between aortic stiffness and left ventricular function in patients with Cushing’s disease

Bayram

Ersoy

Sen

et al. 2010

Endocr

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We aimed to investigate the aortic function and to evaluate the relationship between aortic stiffness and systolic and diastolic functions of the left ventricle in patients with Cushing's disease (CD). Fourteen women and one man with newly diagnosed CD, and 17 control cases were enrolled in this study. All subjects underwent echocardiography and systolic and diastolic aortic measurements were noted from M-mode aortic root. Aortic elastic parameters, aortic strain, and distensibility were calculated. Left ventricle functions were measured using echocardiography including, two-dimensional, M-mode, conventional Doppler, and tissue Doppler imaging. Aortic strain (7.4 ± 1.9 vs. 12.3 ± 2.4%; P < 0.001), and aortic distensibility (3.2 ± 1.1 × 10⁻⁶ vs. 5.6 ± 1.4 × 10⁻⁶ cm² dyn⁻¹; P < 0.001) were significantly decreased in patient group compared with control group. Mitral E velocity and the ratio of E/A were significantly lower and deceleration time of E was significantly prolonged in patients with CD. We also observed that patients with CD had markedly lower early diastolic myocardial peak velocity (Em) and Em/Am ratio and higher Tei index than in control group. Aortic elastic parameters are deranged in patients with CD and there is a significant correlation between left ventricular parameters determined by tissue Doppler echocardiography and aortic elastic parameters in these patients. We think that patients with CD should also be evaluated with aortic stiffness known to be an early marker for atherosclerosis.

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Section: Discussionsupporting

confidence: 93%

The relationship between aortic stiffness and left ventricular function in patients with Cushing’s disease

Bayram

Ersoy

Sen

et al. 2010

Endocr

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“…Atherosclerotic plaques are more prevalent in CD patients than in the control population even after long-term remission and correlation with insulin resistance and central adiposity (1,173). IMT correlated with waist-hip-ratio and fasting glucose, but no correlation was found with the cortisol levels (173).…”

Section: European Journal Of Endocrinologymentioning

confidence: 91%

Metabolic comorbidities in Cushing's syndrome

Ferraú

Korbonits

2015

European Journal of Endocrinology

146

121

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Cushing's syndrome (CS) patients have increased mortality primarily due to cardiovascular events induced by glucocorticoid (GC) excess-related severe metabolic changes. Glucose metabolism abnormalities are common in CS due to increased gluconeogenesis, disruption of insulin signalling with reduced glucose uptake and disposal of glucose and altered insulin secretion, consequent to the combination of GCs effects on liver, muscle, adipose tissue and pancreas. Dyslipidaemia is a frequent feature in CS as a result of GC-induced increased lipolysis, lipid mobilisation, liponeogenesis and adipogenesis. Protein metabolism is severely affected by GC excess via complex direct and indirect stimulation of protein breakdown and inhibition of protein synthesis, which can lead to muscle loss. CS patients show changes in body composition, with fat redistribution resulting in accumulation of central adipose tissue. Metabolic changes, altered adipokine release, GC-induced heart and vasculature abnormalities, hypertension and atherosclerosis contribute to the increased cardiovascular morbidity and mortality. In paediatric CS patients, the interplay between GC and the GH/IGF1 axis affects growth and body composition, while in adults it further contributes to the metabolic derangement. GC excess has a myriad of deleterious effects and here we attempt to summarise the metabolic comorbidities related to CS and their management in the perspective of reducing the cardiovascular risk and mortality overall.

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“…In these patients, the carotid vascular damage was significantly and independently correlated with the degree of central adiposity and insulin resistance, demonstrating that these factors mainly contribute to the persistence of vascular damage in patients’ cure of CD. In a different study, an IMT significantly higher than in a population matched for cardiovascular risk factors, such as smoking habit, body mass index, blood pressure, glucose and lipid levels, was described in multiple vascular districts [9]. CS has also been found to be associated with a functional alteration of the vascular system.…”

Section: Vascular Abnormalitiesmentioning

confidence: 99%

Cardiovascular Disease in Cushing’s Syndrome: Heart versus Vasculature

Leo

Pivonello²,

Auriemma³

et al. 2010

Neuroendocrinology

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Cushing’s syndrome (CS) causes metabolic abnormalities that determine an increased cardiovascular risk not only during the active phase of the disease but also for a long time after cure. Cardiovascular complications, such as premature atherosclerosis, coronary artery disease, heart failure, and stroke, in patients with CS cause a mortality rate higher than that observed in a normal population. The increased cardiovascular risk is mainly due to metabolic complications, such as metabolic syndrome, but also to vascular and cardiac alterations such as atherosclerosis and cardiac structural and functional changes. In the clinical management of patients with CS the focus should be on identifying the global cardiovascular risk and the aim should be to control not only hypertension but also other correlated risk factors, such as obesity, glucose intolerance, insulin resistance, dyslipidemia, endothelial dysfunction and the prothrombotic state. Considering that remission from hypercortisolism is often difficult to achieve and that the cardiovascular risk can persist even during disease remission, care and control of all cardiovascular risk factors should be one of the primary goals during the follow-up of these patients.

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Patients with Cushing’s Syndrome Have Increased Intimal Media Thickness at Different Vascular Levels: Comparison with a Population Matched for Similar Cardiovascular Risk Factors

Cited by 62 publications

References 22 publications

The relationship between aortic stiffness and left ventricular function in patients with Cushing’s disease

The relationship between aortic stiffness and left ventricular function in patients with Cushing’s disease

Metabolic comorbidities in Cushing's syndrome

Cardiovascular Disease in Cushing’s Syndrome: Heart versus Vasculature

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