Cardiovascular status in endogenous cortisol excess: the prospective CV-CORT-EX study

医学 内科学 内分泌学 前瞻性队列研究 人口 左心室肥大 代谢综合征 舒张期 心脏病学 队列 血压 肥胖 环境卫生
作者
Caroline Morbach,Mario Detomas,Floran Sahiti,Karolina Hoffmann,Matthias Kroiß,Götz Gelbrich,Stefan Frantz,Stefanie Hahner,Peter U. Heuschmann,Martin Faßnacht,Stefan Störk,Timo Deutschbein
出处
期刊:European journal of endocrinology [Oxford University Press]
标识
DOI:10.1093/ejendo/lvae145
摘要

Abstract Objective Cushing´s syndrome (CS) results in increased cardiovascular morbidity and mortality. Subtype-specific differences and possible reversibility after biochemical cure are not well investigated. Design Prospective cohort study evaluating the cardiovascular status in different forms of endogenous cortisol excess. Methods Patients with overt CS (n=40, 47±13 years, 75% women; 18 pituitary, 13 adrenal, 9 ectopic), biochemically cured CS (n=56, 53±12 years, 79% women; 30 pituitary, 21 adrenal, 5 ectopic), and adrenal incidentalomas with mild autonomous cortisol secretion (MACS) (n=18, 62±11 years, 56% women) underwent comprehensive biochemical, metabolic, and cardiovascular assessment. Results were compared with a representative sample of the general population of Würzburg (n=4965, 55±12 years, 52% women). Results Overt CS was associated with left ventricular (LV) remodeling along with hypertrophy and impaired longitudinal systolic/diastolic function at echocardiography. In 20 CS patients followed for a median of 8 (quartiles: 6, 11) months after biochemical remission, hypertension and hyperglycemia were better controlled, while cardiac alterations only partially improved. Patients with previous CS (median time of biochemical remission: 95 (36, 201) months) had worse diastolic function than the general population (LV relaxation velocity e´ 0.08 (0.07, 0.10) ms-1 vs 0.10 (0.08, 0.12) ms-1, p<0.001). In MACS, cardiac remodeling was even more pronounced than in individuals with metabolic syndrome. Conclusions In patients with overt CS, cured CS, and MACS, we found a sizable and significant deviation from the general population mean regarding cardiac structure and function. Even mild cortisol excess is associated with glucocorticoid-induced cardiac alterations which appear to persist despite long-term biochemical remission.
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