ORIGINAL ARTICLE

Metabolic and cardiovascular outcomes in patients with Cushing's syndrome of different aetiologies during active disease and 1 year after remission

1. Roberta Giordano¹, 
2. Andreea Picu², 
3. Elisa Marinazzo², 
4. Valentina D'Angelo², 
5. Rita Berardelli², 
6. Ioannis Karamouzis², 
7. Daniela Forno¹, 
8. Domenico Zinnà², 
9. Mauro Maccario²,
10. Ezio Ghigo², 
11. Emanuela Arvat²

Article first published online: 5 AUG 2011

DOI: 10.1111/j.1365-2265.2011.04055.x

© 2011 Blackwell Publishing Ltd

Issue

Clinical Endocrinology

Volume 75, Issue 3, pages 354–360, September 2011

Summary

Objective  Cushing's syndrome is associated with several comorbidities responsible for the increased cardiovascular risk, not only during the active phase but also after disease remission.

Design  In 29 patients with Cushing's syndrome (14 Cushing's diseases and 15 adrenal adenomas), waist circumference, fasting and 2-h glucose after oral glucose tolerance test (OGTT), lipid profile and blood pressure were evaluated during the active disease and 1 year after remission and compared with those in 29 sex-, age- and BMI-matched controls.

Results  During the active disease, waist circumference, 2-h glucose after OGTT, total and LDL cholesterol were higher in patients with Cushing's syndrome than in controls (P < 0·001) but similar in Cushing's disease and adrenal adenomas. The prevalence of impaired glucose tolerance (IGT), diabetes mellitus, dyslipidaemia and hypertension was higher (P < 0·001) in patients with Cushing's syndrome (27%, 24%, 59% and 72%) than in controls (10%, 0%, 21% and 10%), with no significant difference between Cushing's disease and adrenal adenomas. One year following hormonal remission, waist circumference persisted higher than in controls (P < 0·05) in both Cushing's disease and adrenal adenomas. Metabolic and cardiovascular abnormalities were still present in both groups, although with a lower prevalence, as well as with a more marked decrease in adrenal adenomas (P < 0·05 vs active disease for IGT, dyslipidaemia and hypertension).

Conclusions  These results show that chronic hypercortisolism, independently of its aetiology, contributes to metabolic impairment and increased cardiovascular risk, while these abnormalities mostly persist in patients with previous Cushing's disease after hormonal remission. Pituitary hormonal deficiencies, hormonal replacement treatments and/or incomplete cure from Cushing's disease may account for these findings.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2011.04055.x/abstract;jsessionid=8826EEB2529F32D58CA4EABCCE3A75E6.d02t03