Hypertension in Cushing’s Syndrome: From Pathogenesis to Treatment
Abstract
Hypertension is one of the most distinguishing features of endogenous Cushing’s syndrome (CS), as it is present in about 80% of adult patients whereas in children its prevalence is about 47%. Hypertension in CS is significantly correlated with the duration of hypercortisolism and results from the interplay between several pathophysiological mechanisms regulating plasma volume, peripheral vascular resistance and cardiac output, all of which are increased in this state. Glucocorticoids cause hypertension through several mechanisms: their intrinsic mineralocorticoid activity; through activation of the renin-angiotensin system; by enhancement of vasoactive substances, and by causing suppression of the vasodilatory systems. In addition, glucocorticoids may exert some hypertensive effects on cardiovascular regulation through the CNS via both glucocorticoid and mineralocorticoid receptors. Hypertension in CS usually resolves with surgical removal of the tumor, but some patients require pharmacological antihypertensive treatment both pre- and postoperatively. Thiazides and furosemide should be avoided, while adrenergic blockade and calcium channel antagonists are usually ineffective. Mineralocorticoid receptor antagonists, Ang II blockers and ACE inhibitors are good anti-hypertensive options; PPAR-γ agonists may help in many aspects of the insulin resistance syndrome. The relatively selective glucocorticoid receptor antagonist Mifepristone (RU 486) could reduce blood pressure in patients with CS. Neuromodulatory agents such as the serotonin inhibitors cyproheptadine and ritanserin, valproid acid, dopamine agonists, somatostatin analogs may occasionally be effective, as well as drugs acting directly at the adrenal levels, such as Ketoconazole and aminoglutetimide or even opDDD. Treating hypertension in CS remains a difficult task and a big challenge, in order to decrease the morbidity and mortality associated with the disease.
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Although small cohort studies suggest high BP is highly prevalent (often exceeding 80%) among patients with Cushing syndrome, the overall frequency of hypertension among patients with Cushing syndrome remains to be accurately characterized.
“Although a variety of relatively small cohort studies suggest that high BP is highly prevalent (often exceeding 80%),324,325 the overall frequency of hypertension, mild or severe, among patients with Cushing syndrome remains to be accurately characterized.”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [324]
Hypercortisolism can promote hypertension through additional pathways including activating the renin-angiotensin system, sensitizing the vasculature to catecholamines, and impairing endogenous nitric oxide bioavailability.
“However, it is also recognized the hypercortisolism can promote hypertension through a variety of additional pathways (eg, activating the renin-angiotensin system, sensitizing the vasculature to catecholamines, and impairing endogenous nitric oxide bioavailability).324,325”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [324]
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- Authors
- Cicala, M. V., & Mantero, F.
- Affiliations
- University of Padua (IT)
- ORCID
- Mantero, Franco
- Venue
- Neuroendocrinology
- Publisher
- S. Karger AG
- Published
- 2010
- Volume
- 92
- Issue
- Suppl. 1
- Pages
- 44-49
- ISSN
- 0028-3835 (ISSN-L)
- 1423-0194
- OpenAlex
- W1992973818
- Cited by
- 112
- References
- 19
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 4 · 2023: 15 · 2022: 9 · 2021: 11 · 2020: 8 · 2019: 6 · 2018: 9 · 2017: 1 · 2016: 13 · 2015: 7 · 2014: 5 · 2013: 5 · 2012: 5
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Padua Research Archive (University of Padova) (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, hypertension, hypercortisolism, glucocorticoid-induced hypertension, mineralocorticoid activity, renin-angiotensin system, systemic vascular resistance, plasma volume, mineralocorticoid receptor antagonists, ACE inhibitors, angiotensin receptor blockers, PPARγ agonists, mifepristone, adrenergic blockade, somatostatin analogues, dopamine agonists, ketoconazole, aminoglutethimide, antihypertensive therapy
- MeSH terms
- Adult, Antihypertensive Agents, Blood Pressure, Cushing Syndrome, Humans, Hypertension, Renin-Angiotensin System
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