Cardiovascular risk and mortality in patients with active and treated hypercortisolism
Open accessAbstract
Patients with hypercortisolism demonstrate high cardiovascular morbidity and mortality, especially if diagnosis is delayed. Hypercortisolism-induced cardiovascular and metabolic comorbidities include hypertension, impaired glucose metabolism, dyslipidemia, and obesity. High prevalence of cardiovascular risk factors leads to increased rate of cardiovascular events and mortality. This risk is reduced, albeit not reversed even after successful treatment of hypercortisolism. In this review we will describe prevalence and mechanisms of cardiovascular comorbidities in patients with hypercortisolism. In addition, we will summarize the effect of therapy on cardiovascular risk factors, events, as well as mortality.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Hypercortisolism is associated with 3.5 to 5 times increased mortality risk compared with the general population.
“Hypercortisolism is associated with an increase in cardiovascular events (myocardial infarction), cerebrovascular events (stroke), sepsis, and thromboembolism with 3.5 to 5 times increased mortality risk compared with the general population (7-11).”
From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [10]
Cites
The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
Nieman, L. K., Biller, B. M. K., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0125 · Cited by 2,718 · cited 3× · see citing works
“Gland Surg 2020;9(1):43-58 | http://dx.”
BackgroundGastaldelli, A., Cusi, K., Pettiti, M., Hardies, J., Miyazaki, Y., Berria, R., Buzzigoli, E., Sironi, A. M., Cersosimo, E., Ferrannini, E., et al. (2007) · Gastroenterology · doi:10.1053/j.gastro.2007.04.068 · Cited by 629 · see citing works
A 12-month phase 3 study of pasireotide in Cushing's disease
Colao, A., Petersenn, S., Newell-Price, J., Findling, J. W., Gu, F., Maldonado, M., Schoenherr, U., Dipl.-Biol., Mills, D., Salgado, L. R., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1105743 · Cited by 628 · see citing works
Fleseriu, M., Biller, B. M. K., Findling, J. W., Molitch, M. E., Schteingart, D. E., Gross, C., on behalf of the SEISMIC Study Investigators, The SEISMIC Study Investigators include, Auchus, R., Bailey, T., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-3350 · Cited by 479 · cited 2× · see citing works
“Mifepristone is the agent approved for patients with CS and hyperglycemia, which can reduce fasting glucose concentrations by around 40 mg/dL (80).”
BackgroundLambillotte, C., Gilon, P., & Henquin, J. C. (1997) · Journal of Clinical Investigation · doi:10.1172/jci119175 · Cited by 419 · see citing works
Valassi, E., Santos, A., Yaneva, M., Tóth, M., Strasburger, C. J., Chanson, P., Wass, J. A. H., Chabre, O., Pfeifer, M., Feelders, R. A., et al. (2011) · European Journal of Endocrinology · doi:10.1530/eje-11-0272 · Cited by 402 · see citing works
Faggiano, A., Pivonello, R., Spiezia, S., De Martino, M. C., Filippella, M., Di Somma, C., Lombardi, G., & Colao, A. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-021558 · Cited by 358 · see citing works
Direct Effect of Glucocorticoids on Lipolysis in Adipocytes
Xu, C., He, J., Jiang, H., Zu, L., Zhai, W., Pu, S., & Xu, G. (2009) · Molecular Endocrinology · doi:10.1210/me.2008-0464 · Cited by 291 · see citing works
Hypertension and the cortisol-cortisone shuttle
Quinkler, M., & Stewart, P. M. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030138 · Cited by 286 · see citing works
Ketoconazole in Cushing's disease: is it worth a try?
Castinetti, F., Guignat, L., Giraud, P., Muller, M., Kamenicky, P., Drui, D., Caron, P., Luca, F., Donadille, B., Vantyghem, M. C., et al. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3628 · Cited by 285 · see citing works
Diagnosis and Treatment of Subclinical Hypercortisolism
Chiodini, I. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2722 · Cited by 279 · cited 1× · see citing works
“Mild autonomous cortisol secretion (MACS) affects around 30% of patients with adrenal tumors (11,12) and is characterized by the presence of metabolic abnormalities in the absence of overt clinical features of CS (12-14).”
BackgroundHigh cardiovascular risk in patients with Cushing’s syndrome according to 1999 WHO/ISH guidelines
Mancini, T., Kola, B., Mantero, F., Boscaro, M., & Arnaldi, G. (2004) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2004.02168.x · Cited by 278 · see citing works
Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas
Debono, M., Bradburn, M., Bull, M., Harrison, B., Ross, R. J., & Newell-Price, J. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3007 · Cited by 269 · cited 3× · see citing works
“Patients with MACS have been reported to have increased risk of cardiovascular events and higher mortality than those with nonfunctional tumors (6,15).”
BackgroundElhassan, Y. S., Alahdab, F., Prete, A., Delivanis, D. A., Khanna, A., Prokop, L., Murad, M. H., O'Reilly, M. W., Arlt, W., & Bancos, I. (2019) · Annals of Internal Medicine · doi:10.7326/m18-3630 · Cited by 263 · see citing works
Self-citationClayton, R. N., Jones, P. W., Reulen, R. C., Stewart, P. M., Hassan-Smith, Z. K., Ntali, G., Karavitaki, N., Dekkers, O. M., Pereira, A. M., Bolland, M., et al. (2016) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(16)30005-5 · Cited by 208 · see citing works
Ketoconazole treatment in Cushing’s syndrome: experience in 34 patients
Sonino, N., Boscaro, M., Paoletta, A., Mantero, F., & Zillotto, D. (1991) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1991.tb03547.x · Cited by 201 · see citing works
Pivonello, R., De Martino, M. C., De Leo, M., Lombardi, G., & Colao, A. (2008) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2007.10.010 · Cited by 195 · see citing works
Connell, J. M. C., Whitworth, J. A., Davies, D. L., Lever, A. F., Richards, A. M., & Fraser, R. (1987) · Journal of Hypertension · doi:10.1097/00004872-198708000-00007 · Cited by 188 · cited 4× · see citing works
“Hypercortisolism leads to increased hepatic production of angiotensinogen (26,31).”
BackgroundInfluentialMortality and morbidity in Cushing's syndrome in New Zealand
Bolland, M. J., Holdaway, I. M., Berkeley, J. E., Lim, S., Dransfield, W. J., Conaglen, J. V., Croxson, M. S., Gamble, G. D., Hunt, P. J., & Toomath, R. J. (2011) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04124.x · Cited by 182 · see citing works
Outcome of Cushing's disease following transsphenoidal surgery in a single center over 20 years
Hassan-Smith, Z. K., Sherlock, M., Reulen, R. C., Arlt, W., Ayuk, J., Toogood, A. A., Cooper, M. S., Johnson, A. P., & Stewart, P. M. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-2957 · Cited by 153 · see citing works
Mortality in Cushing's syndrome: systematic analysis of a large series with prolonged follow-up
Ntali, G., Asimakopoulou, A., Siamatras, T., Komninos, J., Vassiliadi, D., Tzanela, M., Tsagarakis, S., Grossman, A. B., Wass, J. A. H., & Karavitaki, N. (2013) · European Journal of Endocrinology · doi:10.1530/eje-13-0569 · Cited by 149 · see citing works
Overall and Disease-Specific Mortality in Patients With Cushing Disease: A Swedish Nationwide Study
Ragnarsson, O., Olsson, D. S., Papakokkinou, E., Chantzichristos, D., Dahlqvist, P., Segerstedt, E., Olsson, T., Petersson, M., Berinder, K., Bensing, S., et al. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-02524 · Cited by 134 · cited 1× · see citing works
“Causes of death in patients with persistent CD and adrenal CS were reported to be primarily cardiovascular but also from infection or malignancy (74,96).”
BackgroundGiordano, R., Picu, A., Marinazzo, E., D’Angelo, V., Berardelli, R., Karamouzis, I., Forno, D., Zinnà, D., Maccario, M., Ghigo, E., et al. (2011) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04055.x · Cited by 122 · see citing works
Mortality in Cushing's syndrome: data from 386 patients from a single tertiary referral center
Yaneva, M., Kalinov, K., & Zacharieva, S. (2013) · European Journal of Endocrinology · doi:10.1530/eje-13-0320 · Cited by 93 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Approach to the Patient With Adrenal Incidentaloma
Bancos, I., & Prete, A. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab512 · Cited by 201 · see citing works
Self-citationApproach to the Patient: Diagnosis of Cushing Syndrome
Savas, M., Mehta, S., Agrawal, N., van Rossum, E. F. C., & Feelders, R. A. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac492 · Cited by 91 · see citing works
- Authors
- Li, D., El Kawkgi, O. M., Henriquez, A. F., & Bancos, I.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Bancos, Irina
- Venue
- Gland Surgery
- Publisher
- AME Publishing Company
- Published
- 2020-02
- Volume
- 9
- Issue
- 1
- Pages
- 43-58
- ISSN
- 2227-684X (ISSN-L)
- 2227-8575
- PMC
- PMC7082278
- OpenAlex
- W2995794033
- Cited by
- 42
- References
- 24
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 8 · 2021: 8 · 2020: 3
- FWCI
- 0.96
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Gland Surgery (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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
- hypercortisolism, cardiovascular risk, cardiovascular mortality, cardiovascular comorbidity, hypertension, impaired glucose metabolism, dyslipidemia, obesity, Cushing's syndrome, delayed diagnosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
