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Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
Published on: April 25, 2016
Cardiovascular status in endogenous cortisol excess: the prospective CV-CORT-EX study
Caroline Morbach1,2, Mario Detomas3, Floran Sahiti1,2
1Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center Würzburg, 97078 Würzburg, Germany.
Insights
Cushing's syndrome (CS) causes lasting heart damage, even after treatment. Mild excess cortisol also leads to significant cardiac changes, persisting long-term.
Area of Science:
- Endocrinology
- Cardiology
- Internal Medicine
Background:
- Cushing's syndrome (CS) is linked to increased cardiovascular (CV) risks.
- Subtype differences and reversibility of CV issues after cure are understudied.
Purpose of the Study:
- To evaluate cardiovascular status in different forms of endogenous cortisol excess.
- To investigate reversibility of cardiac changes after biochemical cure in CS.
Main Methods:
- Prospective cohort study comparing overt CS, biochemically cured CS, and mild autonomous cortisol secretion (MACS) patients.
- Comprehensive biochemical, metabolic, and CV assessments, including echocardiography.
- Comparison with a general population sample.
Main Results:
- Overt CS shows left ventricular remodeling, hypertrophy, and impaired function.
- Cardiac alterations partially improved after cure, with persistent hypertension and hyperglycemia.
- Previous CS patients had worse diastolic function than the general population.
- MACS patients exhibited pronounced cardiac remodeling.
Conclusions:
- Overt CS, cured CS, and MACS patients exhibit significant cardiac deviations from the general population.
- Glucocorticoid excess, even mild, causes persistent cardiac alterations.
- Cardiac damage may not fully reverse despite long-term biochemical remission.
Objective:
Cushing's syndrome (CS) results in increased cardiovascular (CV) morbidity and mortality. Subtype-specific differences and possible reversibility after biochemical cure are not well investigated.
Design:
Prospective cohort study evaluating the CV status in different forms of endogenous cortisol excess.
Methods:
Patients with overt CS (n = 40, 47 ± 13 years, 75% women; 18 pituitary, 13 adrenal, and 9 ectopic), biochemically cured CS (n = 56, 53 ± 12 years, 79% women; 30 pituitary, 21 adrenal, and 5 ectopic), and adrenal incidentalomas with mild autonomous cortisol secretion (MACS) (n = 18, 62 ± 11 years, 56% women) underwent comprehensive biochemical, metabolic, and CV assessment. Results were compared with a representative sample of the general population of Würzburg (n = 4965, 55 ± 12 years, 52% women).
Results:
Overt CS was associated with left ventricular (LV) remodeling along with hypertrophy and impaired longitudinal systolic/diastolic function at echocardiography. In 20 CS patients followed for a median of 8 (quartiles: 6, 11) months after biochemical remission, hypertension, and hyperglycemia were better controlled, while cardiac alterations only partially improved. Patients with previous CS (median time of biochemical remission: 95 [36, 201] months) had worse diastolic function than the general population (LV relaxation velocity e' 0.08 [0.07, 0.10] ms-1 vs 0.10 [0.08, 0.12] ms-1, P < .001). In MACS, cardiac remodeling was even more pronounced than in individuals with metabolic syndrome.
Conclusions:
In patients with overt CS, cured CS, and MACS, we found a sizable and significant deviation from the general population mean regarding cardiac structure and function. Even mild cortisol excess is associated with glucocorticoid-induced cardiac alterations, which appear to persist despite long-term biochemical remission.
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