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Blood pressure in pediatric patients with Cushing syndrome

Maya B Lodish1, Ninet Sinaii, Nicholas Patronas

  • 1Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, National Institute of Child Health and Human Development, NIH, Building 10, CRC, 10 Center Drive, MSC1103, Bethesda, Maryland 20892, USA. lodishma@mail.nih.gov

The Journal of Clinical Endocrinology and Metabolism
|March 19, 2009
PubMed

Insights

Pediatric Cushing syndrome (CS) patients often have hypertension (HTN) that improves after surgery but can persist. High cortisol levels correlate with blood pressure, and rare serious side effects may occur.

Area of Science:

  • Pediatric Endocrinology
  • Cardiovascular Health in Children
  • Surgical Outcomes

Background:

  • Hypertension (HTN) affects up to 60% of children with Cushing syndrome (CS).
  • The long-term course, side effects, and differences in HTN based on CS cause are understudied.
  • Understanding HTN in pediatric CS is crucial for managing patient outcomes.

Purpose of the Study:

  • To assess blood pressure changes in pediatric CS patients pre- and post-surgery (transsphenoidal surgery or adrenalectomy).
  • To identify the incidence of residual HTN and associated side effects.
  • To compare HTN characteristics between Cushing disease (CD) and ACTH-independent CS (AICS).

Main Methods:

  • Analysis of data from 86 children with CD and 27 children with AICS.
  • Measurement of blood pressure before and after surgical intervention.
  • Evaluation of side effects and rates of residual HTN.

Main Results:

  • Significant preoperative HTN was observed in both CD and AICS groups.
  • AICS patients had a higher rate of systolic HTN (SHTN) preoperatively compared to CD patients (74% vs. 44%).
  • Postoperative HTN significantly decreased, but residual SHTN and diastolic HTN (DHTN) persisted in 16% and 4% (CD) and 21% and 5% (AICS) at one year, respectively. Preoperative blood pressure correlated with cortisol levels. Two patients experienced severe side effects, including hypertensive encephalopathy.

Conclusions:

  • Children with CS remain at risk for residual HTN even after successful surgical treatment.
  • The degree of hypercortisolemia is linked to the severity of HTN.
  • While rare, serious HTN-related complications can occur perioperatively.
Abstract

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