Metabolic and cardiovascular outcomes in patients with Cushing's syndrome of different aetiologies during active disease and 1 year after remission
Metabolic and cardiovascular outcomes in patients with Cushing's syndrome of different aetiologies during active disease and 1 year after remission
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DOI：
10.1111/j.1365-2265.2011.04055.x
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发表时间：
2011-09-01
影响因子：
3.2
通讯作者：
Arvat, Emanuela
中科院分区：
文献类型：
--
作者：
Giordano, Roberta;Picu, Andreea;Arvat, Emanuela
目的库欣综合征（Cushing's syndrome，CHS）与多种合并症有关，这些合并症不仅在活动期而且在疾病缓解后都会增加心血管风险。（14例库欣病和15例肾上腺腺瘤）、腰围、空腹和口服葡萄糖耐量试验（OGTT）后2小时血糖，结果在疾病活动期，腰围，OGTT后2小时血糖，总胆固醇和低密度脂蛋白胆固醇在库欣综合征患者中高于对照组（P < 0.001），但在库欣病和肾上腺腺瘤中相似。库欣综合征患者糖耐量减低（IGT）、糖尿病、血脂异常和高血压的患病率（27%、24%、59%和72%）均高于对照组（10%、0%、21%和10%）（P < 0.001），但库欣病与肾上腺腺瘤之间无显著差异。激素缓解后一年，库欣病和肾上腺腺瘤患者的腰围持续高于对照组（P < 0.05）。代谢和心血管异常在两组中仍然存在，尽管患病率较低，肾上腺腺瘤也有更明显的减少（P < 0.05 vs IGT、血脂异常和高血压的活动性疾病）。结论这些结果表明，慢性皮质醇增多症，独立于其病因，有助于代谢障碍和心血管风险增加，而这些异常大多在激素缓解后的先前库欣病患者中持续存在。垂体激素缺乏、激素替代治疗和/或库欣病治愈不完全可能导致这些结果。
Objective Cushing's syndrome is associated with several comorbidities responsible for the increased cardiovascular risk, not only during the active phase but also after disease remission.Design In 29 patients with Cushing's syndrome (14 Cushing's diseases and 15 adrenal adenomas), waist circumference, fasting and 2-h glucose after oral glucose tolerance test (OGTT), lipid profile and blood pressure were evaluated during the active disease and 1 year after remission and compared with those in 29 sex-, age- and BMI-matched controls.Results During the active disease, waist circumference, 2-h glucose after OGTT, total and LDL cholesterol were higher in patients with Cushing's syndrome than in controls (P < 0.001) but similar in Cushing's disease and adrenal adenomas. The prevalence of impaired glucose tolerance (IGT), diabetes mellitus, dyslipidaemia and hypertension was higher (P < 0.001) in patients with Cushing's syndrome (27%, 24%, 59% and 72%) than in controls (10%, 0%, 21% and 10%), with no significant difference between Cushing's disease and adrenal adenomas. One year following hormonal remission, waist circumference persisted higher than in controls (P < 0.05) in both Cushing's disease and adrenal adenomas. Metabolic and cardiovascular abnormalities were still present in both groups, although with a lower prevalence, as well as with a more marked decrease in adrenal adenomas (P < 0.05 vs active disease for IGT, dyslipidaemia and hypertension).Conclusions These results show that chronic hypercortisolism, independently of its aetiology, contributes to metabolic impairment and increased cardiovascular risk, while these abnormalities mostly persist in patients with previous Cushing's disease after hormonal remission. Pituitary hormonal deficiencies, hormonal replacement treatments and/or incomplete cure from Cushing's disease may account for these findings.