Cardiovascular evaluation and endothelial dysfunction in Cushing syndrome following remission: a prospective study

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Internal Medicine

Background:

• Cushing syndrome (CS) is associated with significant cardiovascular risks.
• Endothelial and cardiovascular functions are often impaired in patients with CS.
• Evaluating changes after remission is crucial for understanding long-term outcomes.

Purpose of the Study:

• To assess endothelial and cardiovascular functions in CS patients before and after remission.
• To evaluate changes in endothelial mediators and pro-inflammatory cytokines.
• To determine the impact of CS remission on cardiovascular health.

Main Methods:

• Adult patients with newly diagnosed endogenous CS were enrolled.
• Evaluations included metabolic parameters (BMI, glucose, lipids), cardiovascular assessments (BP monitoring, CIMT, FMD, echocardiography), and biomarker analysis (ADMA, ET-1, IL-1β, TNF-α).
• A control group matched for age, gender, and BMI was included for comparison.

Main Results:

• CS patients exhibited higher mean arterial pressure (MAP) and carotid intima-media thickness (CIMT), and lower flow-mediated dilation (FMD) and mitral E/A ratio compared to controls.
• Following remission, significant improvements were observed in BMI, lipids, fasting glucose, MAP, and CIMT.
• However, FMD did not improve, and endothelin-1 (ET-1) levels increased post-remission, while ADMA, IL-1β, and TNF-α remained unchanged.

Conclusions:

• Remission of Cushing syndrome leads to improvements in certain cardiovascular parameters.
• Asymmetric dimethyl arginine (ADMA) and endothelin-1 (ET-1) are not consistently reliable markers for endothelial dysfunction in CS.
• Metabolic improvements post-remission do not necessarily translate to changes in serum concentrations of TNF-α and IL-1β.