| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Original Studies |
Department of Molecular and Clinical Endocrinology and Oncology, Federico II University (A.C., R.P., A.F., D.F., M.F., P.M., G.C., G.L.) and Echo-Guided Surgery Unit, S. Maria del Popolo degli Incurabili Hospital (S.S., M.S.), Naples, Italy
Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Ph.D., Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. E-mail: colao{at}unina.it
Patients with Cushing’s disease (CD) mainly die because of cardiovascular accidents. The aim of this study was to evaluate whether patients with CD still have increased cardiovascular risk and suffer from premature atherosclerosis once cured.
Fifteen patients cured from CD for a long term period (5 yr), 30 sex- and age-matched controls, and 30 body mass index (BMI)-matched controls were included in this study. BMI; waist to hip ratio (WHR); systolic (SBP) and diastolic (DBP) blood pressures; serum total, low density lipoprotein (LDL), and high density lipoprotein (HDL) cholesterol; serum triglycerides, fibrinogen, and lipoprotein(a) levels; prothrombin time; activated partial thromboplastine time; and basal and glucose load-stimulated insulin and glucose levels were measured in patients and controls. By echo-Doppler ultrasonography, the intima media thickness (IMT), systolic and diastolic media-media distances, blood systolic (SPV) and diastolic (DPV) peak velocity, systolic (SLD) and diastolic (DLD) lumen diameter, and distensibility coefficient (DC) were measured at both common carotid arteries where the presence, size, and location of atherosclerotic plaques were also evaluated.
Compared with a sex- and age-matched control population, CD patients had BMI (P < 0.001), WHR (P < 0.001), SBP (P < 0.005), DBP (P < 0.05), fasting glucose (P < 0.001) and insulin (P < 0.05), glucose load-stimulated glucose and insulin levels (P < 0.05), total cholesterol (P < 0.05), LDL cholesterol (P < 0.01), fibrinogen (P < 0.01), and lipoprotein(a) (P < 0.05) levels higher and HDL cholesterol levels (P < 0.05) lower than controls. At ultrasonography, in the patients, IMT (P < 0.05), SPV (P < 0.05) and DPV (P < 0.001) were significantly increased whereas SLD (P < 0.001), DLD (P < 0.001), and DC (P < 0.05) were significantly decreased compared to controls. In addition, CD patients had higher WHR (P < 0.05), DBP (P < 0.05), glucose load-stimulated glucose and insulin levels (P < 0.05), and fibrinogen levels (P < 0.01) and lower HDL cholesterol (P < 0.05) levels than BMI-matched controls. At ultrasonography, increased common carotid arteries IMT (P < 0.05) and DPV (P < 0.05) and decreased DLD (P < 0.05) and DC (P < 0.05) were measured in patients compared to those in BMI-matched controls. Atherosclerotic plaques were found in 26.7% of patients, in none of the sex- and age-matched controls, and in 3.3% of the BMI-matched controls. In CD patients, a significant correlation was found between both WHR and fasting serum insulin levels and DBP (r = 0.52 and r = 0.55; P < 0.05), triglycerides levels (r = 0.56 and r = 0.77; P < 0.05), and IMT (r = 0.64 and r = 0.56; P < 0.05). Right (r = -0.70; P < 0.005) and left (r = -0.65; P < 0.01) DC were inversely correlated to the duration of CD in the patient group. At the multiple regression analysis, WHR was the best predictor of fasting insulin levels (ß = 0.77; P < 0.05), and vice versa, fasting insulin level was the best predictor of WHR (ß = 1.20; P < 0.05).
In conclusion, patients cured from CD for a long term period have a high prevalence of atherosclerosis and maintain increased several cardiovascular risk factors of the active disease, probably due to a residual abdominal obesity and/or insulin resistance syndrome.
This article has been cited by other articles:
 |
|
 |
|
  M. Christ-Crain, B. Kola, F. Lolli, C. Fekete, D. Seboek, G. Wittmann, D. Feltrin, S. C. Igreja, S. Ajodha, J. Harvey-White, et al. AMP-activated protein kinase mediates glucocorticoid-induced metabolic changes: a novel mechanism in Cushing's syndrome FASEB J, June 1, 2008; 22(6): 1672 - 1683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. K. Nieman, B. M. K. Biller, J. W. Findling, J. Newell-Price, M. O. Savage, P. M. Stewart, and V. M. Montori The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1526 - 1540. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. R Walker Glucocorticoids and Cardiovascular Disease Eur. J. Endocrinol., November 1, 2007; 157(5): 545 - 559. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Holmer, J. Svensson, L. Rylander, G. Johannsson, T. Rosen, B.-A. Bengtsson, M. Thoren, C. Hoybye, M. Degerblad, M. Bramnert, et al. Nonfatal Stroke, Cardiac Disease, and Diabetes Mellitus in Hypopituitary Patients on Hormone Replacement Including Growth Hormone J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3560 - 3567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A van der Klaauw, N. R Biermasz, E. J M Feskens, M. B Bos, J. W A Smit, F. Roelfsema, E. P M Corssmit, H. Pijl, J. A Romijn, and A. M Pereira The prevalence of the metabolic syndrome is increased in patients with GH deficiency, irrespective of long-term substitution with recombinant human GH Eur. J. Endocrinol., April 1, 2007; 156(4): 455 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. M. Dekkers, N. R. Biermasz, A. M. Pereira, F. Roelfsema, M. O. van Aken, J. H. C. Voormolen, and J. A. Romijn Mortality in Patients Treated for Cushing's Disease Is Increased, Compared with Patients Treated for Nonfunctioning Pituitary Macroadenoma J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 976 - 981. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Qi and B. Rodrigues Glucocorticoids produce whole body insulin resistance with changes in cardiac metabolism Am J Physiol Endocrinol Metab, March 1, 2007; 292(3): E654 - E667. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Pecori Giraldi, M. Andrioli, L. De Marinis, A. Bianchi, A. Giampietro, M. De Martin, E. Sacco, M. Scacchi, A. Pontecorvi, and F. Cavagnini Significant GH deficiency after long-term cure by surgery in adult patients with Cushing's disease Eur. J. Endocrinol., February 1, 2007; 156(2): 233 - 239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P Haentjens, L De Meirleir, R Abs, J Verhelst, K Poppe, and B Velkeniers Glomerular filtration rate in patients with Cushing's disease: a matched case-control study Eur. J. Endocrinol., December 1, 2005; 153(6): 819 - 829. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Faggiano, D. Melis, R. Alfieri, M. De Martino, M. Filippella, F. Milone, G. Lombardi, A. Colao, and R. Pivonello Sulfur Amino Acids in Cushing's Disease: Insight in Homocysteine and Taurine Levels in Patients with Active and Cured Disease J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6616 - 6622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Brotman, J. P. Girod, M. J. Garcia, J. V. Patel, M. Gupta, A. Posch, S. Saunders, G. Y. H. Lip, S. Worley, and S. Reddy Effects of Short-Term Glucocorticoids on Cardiovascular Biomarkers J. Clin. Endocrinol. Metab., June 1, 2005; 90(6): 3202 - 3208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L.-A. Li and P.-W. Wang PCB126 Induces Differential Changes in Androgen, Cortisol, and Aldosterone Biosynthesis in Human Adrenocortical H295R Cells Toxicol. Sci., May 1, 2005; 85(1): 530 - 540. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Schulman, P. R. Muskin, and P. A. Shapiro Psychiatry and Cardiovascular Disease Focus, April 1, 2005; 3(2): 208 - 224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Colao, C. Di Somma, F. Rota, R. Pivonello, M. C. Savanelli, S. Spiezia, and G. Lombardi Short-Term Effects of Growth Hormone (GH) Treatment or Deprivation on Cardiovascular Risk Parameters and Intima-Media Thickness at Carotid Arteries in Patients with Severe GH Deficiency J. Clin. Endocrinol. Metab., April 1, 2005; 90(4): 2056 - 2062. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Wei, T. M. MacDonald, and B. R. Walker Taking Glucocorticoids by Prescription Is Associated with Subsequent Cardiovascular Disease Ann Intern Med, November 16, 2004; 141(10): 764 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Girod and D. J. Brotman Does altered glucocorticoid homeostasis increase cardiovascular risk? Cardiovasc Res, November 1, 2004; 64(2): 217 - 226. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Orio Jr., S. Palomba, L. Spinelli, T. Cascella, L. Tauchmanova, F. Zullo, G. Lombardi, and A. Colao The Cardiovascular Risk of Young Women with Polycystic Ovary Syndrome: An Observational, Analytical, Prospective Case-Control Study J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3696 - 3701. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Terzolo, B. Allasino, S. Bosio, E. Brusa, F. Daffara, M. Ventura, E. Aroasio, G. Sacchetto, G. Reimondo, A. Angeli, et al. Hyperhomocysteinemia in Patients with Cushing's Syndrome J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3745 - 3751. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P C Souverein, A Berard, T P Van Staa, C Cooper, A C G Egberts, H G M Leufkens, and B R Walker Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study Heart, August 1, 2004; 90(8): 859 - 865. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Pivonello, D. Ferone, W. W. de Herder, J. M. Kros, M. L. Del Basso De Caro, M. Arvigo, L. Annunziato, G. Lombardi, A. Colao, L. J. Hofland, et al. Dopamine Receptor Expression and Function in Corticotroph Pituitary Tumors J. Clin. Endocrinol. Metab., May 1, 2004; 89(5): 2452 - 2462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Arnaldi, A. Angeli, A. B. Atkinson, X. Bertagna, F. Cavagnini, G. P. Chrousos, G. A. Fava, J. W. Findling, R. C. Gaillard, A. B. Grossman, et al. Diagnosis and Complications of Cushing's Syndrome: A Consensus Statement J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5593 - 5602. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Muiesan, M. Lupia, M. Salvetti, C. Grigoletto, N. Sonino, M. Boscaro, E. A. Rosei, F. Mantero, and F. Fallo Left ventricular structural and functional characteristics in Cushing's syndrome J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2275 - 2279. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Faggiano, R. Pivonello, S. Spiezia, M. C. De Martino, M. Filippella, C. Di Somma, G. Lombardi, and A. Colao 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., June 1, 2003; 88(6): 2527 - 2533. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Faggiano, R. Pivonello, D. Melis, M. Filippella, C. Di Somma, M. Petretta, G. Lombardi, and A. Colao Nephrolithiasis in Cushing's Disease: Prevalence, Etiopathogenesis, and Modification after Disease Cure J. Clin. Endocrinol. Metab., May 1, 2003; 88(5): 2076 - 2080. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Tauchmanova, R. Rossi, B. Biondi, M. Pulcrano, V. Nuzzo, E.-A. Palmieri, S. Fazio, and G. Lombardi Patients with Subclinical Cushing's Syndrome due to Adrenal Adenoma Have Increased Cardiovascular Risk J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 4872 - 4878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Lindholm, S. Juul, J. O. L. Jørgensen, J. Astrup, P. Bjerre, U. Feldt-Rasmussen, C. Hagen, J. Jørgensen, M. Kosteljanetz, L. O. Kristensen, et al. Incidence and Late Prognosis of Cushing's Syndrome: A Population-Based Study J. Clin. Endocrinol. Metab., January 1, 2001; 86(1): 117 - 123. [Abstract] [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Endocrinology | Endocrine Reviews | J. Clin. End. & Metab. |
| Molecular Endocrinology | Recent Prog. Horm. Res. | All Endocrine Journals |
