Endocrine Abstracts

Background: Patients with Cushing’s syndrome (CS) have a lot of complications due to chronic exposure of cortisol.

Aim: To reveal specific changes of cardiovascular system in patients with CS.

Material and methods: i) Six patients with CS (five females, one male, 47.1±1.5 years old), duration of CS 3.4±1.2 years, ii) 19 healthy patients (48.1±3.0 years old), and iii) ten patients with ischemic heart disease (IHD) (48.2±3.1 years old). Echocardiography; Holter monitoring (HM) and 24-h ambulatory blood pressure monitoring (ABPM) in bifunctional mode with program assessment of hemodynamic parameters and arterial stiffness (total peripheral vascular resistance (TPVR), index of arterial stiffness, heart rate variability, and circadian index) were assessed.

Results: Arterial hypertension was in all patients with CS. Mean daily BP 176±8/100±6 mmHg. Systolic pressure–time index 67.7±8.7%, diastolic pressure–time index 89.3±10.5%. 24-h rhythms of BP were disturbed in 67%, with prevalence of non-dippers and night-pickers in CS-patients. Strong correlations were found between cortisol levels (0800 and 2300 h) and systolic (SBP) and diastolic (DBP) day and night pressure (for 0800 h cortisol: SBP r=0.75, DBP r=0.8 (P=0.05); and 2300 h cortisol: SPB r=0.9, P=0.01; DPB r=0.95, P=0.05). Index of arterial stiffness was higher in patients with CS in comparison with patients with IHD. TPVR was increased in all patients with CS. Echocardiography: left atrial expansion in 67% of patients (4.2±1.1 cm), left ventricular hyperthrophy (in 50%), diastolic dysfunction (in 67%). Holter: mean heart rate (day 91.6±3.2 and night 73.5±3.8) were higher in patients with CS than in other groups. 83.3% CS-patients had cardiac rhythm abnormalities that show predominance of activity of sympathetic nervous system.

Conclusion: All tests reveal significant changes in cardiovascular system in patients with CS with great predominance of activity of sympathetic nervous system. Index of arterial stiffness in patients with CS were higher than in patients with IHD, leads to higher risk of serious cardiovascular events in CS.