6533b858fe1ef96bd12b58d8
RESEARCH PRODUCT
The hypertension of Cushing's syndrome: Controversies in the pathophysiology and focus on cardiovascular complications
Am IsidoriC GraziadioRm ParagliolaA CozzolinoAg AmbrogioA ColaoSm CorselloR PivonelloN AlbigerG ArnaldiE ArvatR BaldelliR BerardelliM BoscaroSalvatore Cannavo'F CavagniniA De BartolomeisM De LeoG Di MinnoC Di SommaK EspositoG FabbrociniD FeroneC ForestaM GalderisiC GiordanoD GiuglianoA GiustinaF GrimaldiE JanniniF LombardoL ManettiM MannelliF ManteroG MaroneG MazziottiS MorettiE NazzariR PasqualiS PecorelliF Pecori GiraldiC PivonelloG ReimondoC ScaroniA ScillitaniC SimeoliA StiglianoV ToscanoL TrementinoG VitaleMc Zatellisubject
Maleantihypertensive treatment; blood pressure; corticosteroids; Cushing's syndrome; hypercortisolism; hypertension; metabolic syndrome; vascular system; Animals; Blood Pressure; Cushing Syndrome; Female; Glucocorticoids; Humans; Hypertension; Male; Metabolic Syndromemedicine.medical_specialtyPhysiologyHypercortisolismReviewsCushing's syndromecorticosteroidsSettore MED/13 - EndocrinologiaCushing syndromeInternal medicineAntihypertensive treatmentInternal MedicineAnimalsHumansMedicineCorticosteroidIntensive care medicineCushing SyndromeGlucocorticoidsS syndromebusiness.industrymedicine.diseaseMetabolic syndromeantihypertensive treatment blood pressure corticosteroids Cushing's syndrome hypercortisolism; hypertension metabolic syndrome vascular systemPathophysiologyClinical trialCritical appraisalEndocrinologyBlood pressureVascular systemantihypertensive treatment; blood pressure; corticosteroids; Cushing's syndrome; hypercortisolism; hypertension; metabolic syndrome; vascular systemHypertensionBlood pressureFemaleAntihypertensive treatment; Blood pressure; Corticosteroids; Cushing's syndrome; Hypercortisolism; Hypertension; Metabolic syndrome; Vascular system; Internal Medicine; Physiology; Cardiology and Cardiovascular MedicineMetabolic syndromebusinessCardiology and Cardiovascular MedicineGlucocorticoidmedicine.drugdescription
Cushing's syndrome is associated with increased mortality, mainly due to cardiovascular complications, which are sustained by the common development of systemic arterial hypertension and metabolic syndrome, which partially persist after the disease remission. Cardiovascular diseases and hypertension associated with endogenous hypercortisolism reveal underexplored peculiarities. The use of exogenous corticosteroids also impacts on hypertension and cardiovascular system, especially after prolonged treatment. The mechanisms involved in the development of hypertension differ, whether glucocorticoid excess is acute or chronic, and the source endogenous or exogenous, introducing inconsistencies among published studies. The pleiotropic effects of glucocorticoids and the overlap of the several regulatory mechanisms controlling blood pressure suggest that a rigorous comparison of in-vivo and in-vitro studies is necessary to draw reliable conclusions. This review, developed during the first ‘Altogether to Beat Cushing's syndrome’ workshop held in Capri in 2012, evaluates the most important peculiarities of hypertension associated with CS, with a particular focus on its pathophysiology. A critical appraisal of most significant animal and human studies is compared with a systematic review of the few available clinical trials. A special attention is dedicated to the description of the clinical features and cardiovascular damage secondary to glucocorticoid excess. On the basis of the consensus reached during the workshop, a pathophysiology-oriented therapeutic algorithm has been developed and it could serve as a first attempt to rationalize the treatment of hypertension in Cushing's syndrome.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2014-11-22 |