Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-12-01T00:14:57.272Z Has data issue: false hasContentIssue false

Increased arterial rigidity in children affected by Cushing’s syndrome after successful surgical cure

Published online by Cambridge University Press:  21 May 2010

Pier Paolo Bassareo*
Affiliation:
Department of Cardiovascular and Neurological Sciences, University of Cagliari, Cagliari, Italy
Andrea Raffaele Marras
Affiliation:
Study Center for Cardiac Disease in Paediatric Age, University of Cagliari, Cagliari, Italy
Daniele Pasqualucci
Affiliation:
Department of Cardiovascular and Neurological Sciences, University of Cagliari, Cagliari, Italy
Giuseppe Mercuro
Affiliation:
Department of Cardiovascular and Neurological Sciences, University of Cagliari, Cagliari, Italy
*
Correspondence to: P. P. Bassareo, MD, Department of Cardiovascular and Neurological Sciences, University of Cagliari, Policlinico Universitario, S.S. 554, bivio di Sestu – 09042 Monserrato (Cagliari), Italy. Tel: +39 070 675 4953; Fax: +39 070 675 4953; E-mail: [email protected]

Abstract

Background

Complications, such as secondary hypertension, probably related to the loss of arterial elasticity, frequently arise in Cushing’s syndrome, and may persist even beyond cure. This study aimed at demonstrating that arterial compliance, evaluated by automated recording of the QKd interval, was lower in children after a successful surgery for Cushing’s syndrome than in a control group of healthy subjects.

Methods

In all, 23 young girls aged between 11 and 18 years who had undergone a surgical cure for Cushing syndrome – 18 with a pituitary adenoma, three with a primary adrenal disease, and two suffering from ectopic adrenocorticotrope hormone secretion – were enrolled. Arterial stiffness was measured by the standardised non-invasive QKd 100-60 method. A 24-hour ambulatory blood pressure monitoring and a transthoracic echocardiography were also performed.

Results

The children operated for Cushing’s syndrome showed disadvantageous differences in 24-hour ambulatory blood pressure monitoring and in QKD 100-60 value, with p less than 0.01, compared with the control group.

Conclusions

In spite of its successful surgical cure, Cushing’s syndrome results in a significantly decreased arterial distensibility when compared with the control group, which might explain these differences in blood pressure levels. It underlines a significantly higher cardiovascular risk, notwithstanding both the normalisation of cortisol secretion and the very early age of the patients.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Cushing, HW. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Bull Johns Hopkins Hosp 1932; 50: 137195.Google Scholar
2. Nieman, LK, Biller, BM, Findling, JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2008; 93: 15261540.CrossRefGoogle ScholarPubMed
3. Magiakou, MA, Mastorakos, G, Oldfield, EH, et al. Cushing’s syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med 1994; 331: 629636.CrossRefGoogle ScholarPubMed
4. Colao, A, Pivonello, R, Spiezia, S, et al. Persistence of increased cardiovascular risk in patients with Cushing’s disease after five years of successful cure. J Clin Endocrinol Metab 1999; 84: 26642672.Google ScholarPubMed
5. Hunt, TK, Roizen, MF, Tyrrell, JB, Biglieri, EG. Current achievements and challenges in adrenal surgery. Br J Surg 1984; 71: 983985.CrossRefGoogle ScholarPubMed
6. Baykan, M, Erem, C, Gedikli, O, et al. Impairment of flow-mediated vasodilatation of the brachial artery in patients with Cushing’s syndrome. Endocrine 2007; 31: 300304.CrossRefGoogle ScholarPubMed
7. Faggiano, A, Pivonello, R, Spiezia, S, et al. Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing’s disease during active disease and 1 year after disease remission. J Clin Endocrinol Metab 2003; 88: 25272533.CrossRefGoogle ScholarPubMed
8. Arnaldi, G, Angeli, A, Atkinson, AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 2003; 88: 55935602.CrossRefGoogle ScholarPubMed
9. Summers, SA, Nelson, DH. A role for sphingolipids in producing the common features of type 2 diabetes, metabolic syndrome X, and Cushing’s syndrome. Diabetes 2005; 54: 591602.CrossRefGoogle ScholarPubMed
10. Rizzoni, D, Porteri, E, De Ciuceis, C, et al. Hypertrophic remodeling of subcutaneous small resistance arteries in patients with Cushing’s syndrome. J Clin Endocrinol Metab 2009; 94: 50105018.CrossRefGoogle ScholarPubMed
11. Zacharieva, S, Orbetzova, M, Stoynev, A, et al. Circadian blood pressure profile in patients with Cushing’s syndrome before and after treatment. J Endocrinol Invest 2004; 27: 924930.CrossRefGoogle ScholarPubMed
12. Panarelli, M, Terzolo, M, Piovesan, A, et al. 24-hours profiles of blood pressure and heart rate in Cushing’s syndrome. Evidence for differential control of cardiovascular variables by glucocorticoids. Ann Ital Med Int 1990; 5: 1825.Google Scholar
13. Fallo, F, Sonino, N, Barzon, L, et al. Effect of surgical treatment on hypertension in Cushing’s syndrome. Am J Hypert 1996; 9: 7780.CrossRefGoogle ScholarPubMed
14. Gosse, P, Guillo, P, Ascher, G, Clementy, J. Assessment of arterial distensibility by monitoring the timing of Korotkoff sounds. Am J Hypertens 1994; 7: 228233.CrossRefGoogle ScholarPubMed
15. Clark, JA, Lieh-Lai, MW, Sarnaik, A, Mattoo, TK. Discrepancies between direct and indirect blood pressure measurements using various recommendations for arm cuff selection. Pediatrics 2002; 110: 920923.CrossRefGoogle ScholarPubMed
16. Gosse, P, Braunstein, C, Clementy, J. Beyond blood pressure measurements: monitoring of the appearance time of Korotkoff sounds. Blood Press Monit 1996; 1: 193195.Google ScholarPubMed
17. Devereux, RB, Reichek, N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977; 55: 613618.CrossRefGoogle ScholarPubMed
18. Gosse, P, Jullien, V, Lemetayer, P, Jarnier, P, Clementy, J. Ambulatory measurement of the timing of Korotkoff sounds in a group of normal subjects: influence of age and height. Am J Hypertens 1999; 12: 231235.CrossRefGoogle Scholar
19. Lodish, MB, Sinaii, N, Patronas, N, et al. Blood pressure in pediatric patients with Cushing syndrome. J Clin Endocrin Metab 2009; 94: 20022008.CrossRefGoogle ScholarPubMed
20. Benetos, A, Laurent, S, Asmar, RG, Lacolley, P. Large artery stiffness in hypertension. J Hypertens Suppl 1997; 15: S89S97.CrossRefGoogle ScholarPubMed
21. Gosse, P, Gasparoux, P, Ansoborlo, P, Lemetayer, P, Clementy, J. Prognostic value of ambulatory measurement of the timing of Korotkoff sounds in elderly hypertensives: a pilot study. Am J Hypertens 1997; 10: 552557.CrossRefGoogle ScholarPubMed
22. Sacerdote, A, Weiss, K, Tran, T, Rokeya Noor, B, McFarlane, SI. Hypertension in patients with Cushing’s disease: pathophysiology, diagnosis, and management. Curr Hypert Rep 2005; 7: 212218.CrossRefGoogle ScholarPubMed