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Patients with Subclinical Cushing’s Syndrome due to Adrenal Adenoma Have Increased Cardiovascular Risk
Abstract
Subclinical Cushing's syndrome (SCS) is increasingly being reported in incidentally discovered adrenal adenomas; its hallmark is mild autonomous cortisol hyperproduction without specific clinical signs of cortisol excess. Increased prevalence of hypertension, obesity, and impaired glucose tolerance have been described in SCS, but there is no specific study of the risk factors for cardiovascular diseases. In this cross-sectional study we assessed the cardiovascular profile in 28 consecutive SCS patients (19 women and 9 men; aged 56 +/- 10.6 yr) compared with 100 controls matched for age, gender, and body mass index. Systolic (P < 0.001) and diastolic (P < 0.005) blood pressures were higher in patients, as were fasting glucose, insulin, total cholesterol, triglycerides (all P < 0.001), and fibrinogen (P < 0.05). Moreover, the insulin resistance index was increased in patients as was the waist to hip ratio and mean carotid artery intima-media thickness (all P < 0.001). Of the patients, 60.7% had arterial hypertension, 71.4% had lipid abnormalities, 28.6% had impaired glucose tolerance, 35.7% type 2 diabetes mellitus, and 53.6% had abnormalities in hemostatic parameters. Atherosclerotic plaques were more frequent in patients (P < 0.0001). Only 4 (14.3%) patients did not have multiple risk factors for cardiovascular events. Six (21.3%) had clinical evidence of cardiovascular disease; another 11 (39.3%) had cardiovascular abnormalities as revealed by ultrasound scanning of carotid arteries and/or electrocardiogram records. These results strongly suggest that an increased cardiovascular risk profile, similar to that described in overt Cushing's syndrome, is present in SCS subjects. This finding supports the concept that chronic mild endogenous cortisol excess may have important systemic effects on the human body.
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“Despite the absence of florid signs and symptoms, ACS in patients AI has been associated with hypertension (215), insulin resistance (216), type 2 diabetes mellitus (217), obesity (218), metabolic syndrome (219), and increased mortality (75).”
From Adrenal incidentaloma (2020) · cites this paper as [219]
In the citing paper
“Focusing on glucose metabolism, the prevalence of IGT or DM has been higher in patients with SCS than in cases of nonfunctioning adenoma or controls (, , , , , , ), but these data were not confirmed by other studies that found much the same prevalence of these comorbidities in SCS as in the overall series of AI and in the general population (, -).”
From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [201]
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Metadata
- Authors
- Tauchmanovà, L., Rossi, R., Biondi, B., Pulcrano, M., Nuzzo, V., Palmieri, E.-A., Fazio, S., & Lombardi, G.
- Affiliations
- Federico II University Hospital (IT)
- Corresponding author
- Tauchmanovà, Libuse
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2002-11
- Volume
- 87
- Issue
- 11
- Pages
- 4872-4878
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2151843074
- Cited by
- 400
- References
- 47
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 8 · 2023: 14 · 2022: 8 · 2021: 20 · 2020: 14 · 2019: 20 · 2018: 19 · 2017: 12 · 2016: 22 · 2015: 21 · 2014: 19 · 2013: 24 · 2012: 27
- FWCI
- 10.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- subclinical Cushing's syndrome, adrenal adenoma, cardiovascular risk, hypertension, insulin resistance, impaired glucose tolerance, type 2 diabetes, dyslipidemia, atherosclerosis, carotid intima-media thickness, hemostatic disorders, cortisol excess
- MeSH terms
- Adenoma, Adrenal Gland Neoplasms, Adult, Aged, Arteriosclerosis, Blood Glucose, Blood Pressure, Body Constitution, Cardiovascular Diseases, Carotid Arteries, Cholesterol, Cushing Syndrome, Diabetes Mellitus, Type 2, Diastole, Fasting, Female, Fibrinogen, Humans, Hyperlipidemias, Hypertension, Insulin, Insulin Resistance, Male, Middle Aged, Risk Factors, Systole, Triglycerides, Ultrasonography, Body Mass Index, Glucose Intolerance
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