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Cited by 278Pituitary Gland Disorders and TreatmentsHormonal Regulation and HypertensionAdrenal and Paraganglionic Tumors

High cardiovascular risk in patients with Cushing’s syndrome according to 1999 WHO/ISH guidelines

Mancini, Tatiana, Kola, Blerina, Mantero, Franco, Boscaro, Marco, Arnaldi, Giorgio·2004·Clinical Endocrinology
DOI 10.1111/j.1365-2265.2004.02168.x
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Abstract

OBJECTIVE: In patients with Cushing's syndrome (CS) cardiovascular complications determine a mortality rate four times higher than in an age- and gender-matched population. Therefore, we calculated the global cardiovascular risk in patients with CS. DESIGN AND PATIENTS: We applied the World Health Organization--International Society of Hypertension (WHO/ISH) 1999 guidelines for the estimation of cardiovascular risk in 38 females and 11 males with CS; 27 pituitary adenomas, 15 adrenal adenomas, four adrenal carcinomas and three ectopic ACTH-secreting tumours. The risk of major cardiovascular events was estimated considering the combined effect of several risk factors (hypertension, diabetes, etc.), organ damage (left ventricular hypertrophy (LVH), proteinuria, etc.) and associated pathologies. Four categories of absolute cardiovascular disease risk were defined (low, medium, high, very high). RESULTS: Eighty per cent of patients presented a 'high' or 'very high' cardiovascular risk; 85.1% of the patients were hypertensive with a mild-moderate hypertension (68%). Forty-seven per cent of patients were diabetics and 41.3% were obese. Hyperlipidaemia was less frequent (37.5%). Fasting glycaemia was the only cardiovascular risk factor that correlated with a degree of hypercortisolism. Duration of disease correlated with the presence of obesity (P < 0.0008) and hypertension (P < 0.03) but not with the presence of diabetes or dyslipidaemia and seemed to be the only significant predictor of cardiovascular risk (P = 0.03). CONCLUSIONS: Patients with active CS present a remarkably increased cardiovascular risk. Considering that the biochemical cure of hypercortisolism is often difficult to obtain, especially in Cushing's disease, and that cardiovascular risk could persist even after the 'cure', control of risk factors should be one of the primary goals of the therapy.

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Crossref · 10.1111/j.1365-2265.2004.02168.x

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  • Among patients with endogenous Cushing syndrome, 20% to 45% have diabetes and 10% to 30% have defective glucose tolerance, so overall prevalence of glucose metabolism impairment can approach 70%.

    “From % to % of patients with endogenous CS have DM, and % to % have defective glucose tolerance, so the overall prevalence of glucose metabolism impairments can come close to %, as shown in Table  (, , -).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [185]

  • Fasting plasma glucose may not suffice to assess glucose homeostasis in Cushing syndrome because 64% of patients with endogenous Cushing syndrome and diabetes have normal fasting glucose levels.

    “Fasting plasma glucose (FPG) level may not suffice to assess glucose homeostasis in CS because more than one in two patients (%) with endogenous CS and DM have normal FGP levels () and because an oral glucose tolerance test (OGTT) is not always performed in patients with apparently normal fasting glycemia ().”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [185]

  • The onset of diabetes does not seem to correlate with the duration of endogenous Cushing syndrome.

    “Diabetes can develop irrespective of the etiology of cortisol excess in patients with endogenous CS (, ), and its onset does not seem to correlate with the duration of the latter disease ().”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [185]

  • The severity of hypercortisolism correlates with the presence of insulin resistance and diabetes, as shown by an association with higher urinary free cortisol levels, though not all studies found this.

    “Generally speaking, the severity of hypercortisolism correlates with the presence of IR and DM, as evidenced by an association with higher urinary free cortisol (UFC) levels (, ), though this was not identified in all studies (, ).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [185]

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Authors
Mancini, T., Kola, B., Mantero, F., Boscaro, M., & Arnaldi, G.
Affiliations
  • Marche Polytechnic University (IT)
  • University of Padua (IT)
Corresponding author
Arnaldi, Giorgio
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2004-12
Volume
61
Issue
6
Pages
768-777
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/j.1365-2265.2004.02168.x
OpenAlex
W2103539163
Cited by
278
References
40
Citations by year
2026: 11 · 2025: 6 · 2024: 13 · 2023: 8 · 2022: 16 · 2021: 12 · 2020: 15 · 2019: 10 · 2018: 16 · 2017: 15 · 2016: 15 · 2015: 24 · 2014: 15 · 2013: 15 · 2012: 17
FWCI
4.96
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2 d)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
  • Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
Keywords
Cushing's syndrome, cardiovascular risk, hypertension, diabetes mellitus, obesity, hyperlipidemia, left ventricular hypertrophy, proteinuria, hypercortisolism, disease duration, pituitary adenoma, adrenal adenoma, Cushing's disease, cardiovascular risk factors
MeSH terms
Adult, Cardiovascular Diseases, Cushing Syndrome, Diabetes Mellitus, Female, Humans, Hyperlipidemias, Hypertension, Male, Middle Aged, Obesity, Risk, Time Factors

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