| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Special Feature |
Departments of Molecular and Clinical Endocrinology and Oncology (L.T., R.R., B.B., M.P., V.N., G.L.) and Internal Medicine (E.-A.P., S.F.), University Federico II, Naples, Italy
Address all correspondence and requests for reprints to: Dr. Libuse Tauchmanovà, Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Via S. Pansini n. 5, 801 31 Naples, Italy. E-mail: tauchman{at}unina.it.
Abstract
Subclinical Cushing’s syndrome (SCS) is increasingly being reported in incidentally discovered adrenal adenomas; its hallmark is mild autonomous cortisol hyperproduction without specific clinical signs of cortisol excess. Increased prevalence of hypertension, obesity, and impaired glucose tolerance have been described in SCS, but there is no specific study of the risk factors for cardiovascular diseases. In this cross-sectional study we assessed the cardiovascular profile in 28 consecutive SCS patients (19 women and 9 men; aged 56 ± 10.6 yr) compared with 100 controls matched for age, gender, and body mass index. Systolic (P < 0.001) and diastolic (P < 0.005) blood pressures were higher in patients, as were fasting glucose, insulin, total cholesterol, triglycerides (all P < 0.001), and fibrinogen (P < 0.05). Moreover, the insulin resistance index was increased in patients as was the waist to hip ratio and mean carotid artery intima-media thickness (all P < 0.001). Of the patients, 60.7% had arterial hypertension, 71.4% had lipid abnormalities, 28.6% had impaired glucose tolerance, 35.7% type 2 diabetes mellitus, and 53.6% had abnormalities in hemostatic parameters. Atherosclerotic plaques were more frequent in patients (P < 0.0001). Only 4 (14.3%) patients did not have multiple risk factors for cardiovascular events. Six (21.3%) had clinical evidence of cardiovascular disease; another 11 (39.3%) had cardiovascular abnormalities as revealed by ultrasound scanning of carotid arteries and/or electrocardiogram records. These results strongly suggest that an increased cardiovascular risk profile, similar to that described in overt Cushing’s syndrome, is present is SCS subjects. This finding supports the concept that chronic mild endogenous cortisol excess may have important systemic effects on the human body.
This article has been cited by other articles:
 |
|
 |
|
  M. Terzolo, G. Reimondo, and A. Angeli Definition of an optimal strategy to evaluate and follow-up adrenal incidentalomas: time for further research Eur. J. Endocrinol., October 1, 2009; 161(4): 529 - 532. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Van Zaane, E. Nur, A. Squizzato, O. M. Dekkers, M. B. Twickler, E. Fliers, V. E. A. Gerdes, H. R. Buller, and D. P. M. Brandjes Hypercoagulable State in Cushing's Syndrome: A Systematic Review J. Clin. Endocrinol. Metab., August 1, 2009; 94(8): 2743 - 2750. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Anagnostis, V. G. Athyros, K. Tziomalos, A. Karagiannis, and D. P. Mikhailidis The Pathogenetic Role of Cortisol in the Metabolic Syndrome: A Hypothesis J. Clin. Endocrinol. Metab., August 1, 2009; 94(8): 2692 - 2701. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Q. Reuwer, M. T. Twickler, B. A. Hutten, F. W. Molema, N. J. Wareham, G. M. Dallinga-Thie, R. L. Bogorad, V. Goffin, M. Smink-Bol, J. J.P. Kastelein, et al. Prolactin Levels and the Risk of Future Coronary Artery Disease in Apparently Healthy Men and Women Circ Cardiovasc Genet, August 1, 2009; 2(4): 389 - 395. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Sereg, A. Szappanos, J. Toke, K. Karlinger, K. Feldman, E. Kaszper, I. Varga, E. Glaz, K. Racz, and M. Toth Atherosclerotic risk factors and complications in patients with non-functioning adrenal adenomas treated with or without adrenalectomy: a long-term follow-up study Eur. J. Endocrinol., April 1, 2009; 160(4): 647 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. A. Aziz, H. Pijl, M. Frolich, A. W. M. van der Graaf, F. Roelfsema, and R. A. C. Roos Increased Hypothalamic-Pituitary-Adrenal Axis Activity in Huntington's Disease J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1223 - 1228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Fagour, S. Bardet, V. Rohmer, Y. Arimone, P. Lecomte, N. Valli, and A. Tabarin Usefulness of adrenal scintigraphy in the follow-up of adrenocortical incidentalomas: a prospective multicenter study Eur. J. Endocrinol., February 1, 2009; 160(2): 257 - 264. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-L. Nunes, S. Vattaut, J.-B. Corcuff, A. Rault, H. Loiseau, B. Gatta, N. Valli, L. Letenneur, and A. Tabarin Late-Night Salivary Cortisol for Diagnosis of Overt and Subclinical Cushing's Syndrome in Hospitalized and Ambulatory Patients J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 456 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Masserini, V. Morelli, S. Bergamaschi, F. Ermetici, C. Eller-Vainicher, A. M. Barbieri, M. A. Maffini, A. Scillitani, B. Ambrosi, P. Beck-Peccoz, et al. The limited role of midnight salivary cortisol levels in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentaloma Eur. J. Endocrinol., January 1, 2009; 160(1): 87 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S A Whitley, V J Moyes, K M Park, A M Brooke, A B Grossman, S L Chew, A G Rockall, J P Monson, and R H Reznek The appearance of the adrenal glands on computed tomography in multiple endocrine neoplasia type 1 Eur. J. Endocrinol., December 1, 2008; 159(6): 819 - 824. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P K Singh and H N Buch Adrenal incidentaloma: evaluation and management J. Clin. Pathol., November 1, 2008; 61(11): 1168 - 1173. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A. Molnar, C. Lindschau, G. Dubrovska, P. R. Mertens, T. Kirsch, M. Quinkler, M. Gollasch, S. Wresche, F. C. Luft, D. N. Muller, et al. Glucocorticoid-Related Signaling Effects in Vascular Smooth Muscle Cells Hypertension, May 1, 2008; 51(5): 1372 - 1378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Gounarides, M. Korach-Andre, K. Killary, G. Argentieri, O. Turner, and D. Laurent Effect of Dexamethasone on Glucose Tolerance and Fat Metabolism in a Diet-Induced Obesity Mouse Model Endocrinology, February 1, 2008; 149(2): 758 - 766. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Lee, R. Zarnegar, W. T. Shen, E. Kebebew, O. H. Clark, and Q.-Y. Duh Adrenal Incidentaloma, Borderline Elevations of Urine or Plasma Metanephrine Levels, and the "Subclinical" Pheochromocytoma Arch Surg, September 1, 2007; 142(9): 870 - 874. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Golden, S. Malhotra, G. S. Wand, F. L. Brancati, D. Ford, and K. Horton Adrenal Gland Volume and Dexamethasone-Suppressed Cortisol Correlate with Total Daily Salivary Cortisol in African-American Women J. Clin. Endocrinol. Metab., April 1, 2007; 92(4): 1358 - 1363. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. F. Young Jr. The Incidentally Discovered Adrenal Mass N. Engl. J. Med., February 8, 2007; 356(6): 601 - 610. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Subramanian, M. A. DeRosa, C. Bernal-Mizrachi, N. Laffely, W. T. Cade, K. E. Yarasheski, P. E. Cryer, and C. F. Semenkovich PPAR{alpha} activation elevates blood pressure and does not correct glucocorticoid-induced insulin resistance in humans Am J Physiol Endocrinol Metab, December 1, 2006; 291(6): E1365 - E1371. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Chiodini, M. Torlontano, A. Scillitani, M. Arosio, S. Bacci, S. Di Lembo, P. Epaminonda, G. Augello, R. Enrini, B. Ambrosi, et al. Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients Eur. J. Endocrinol., December 1, 2005; 153(6): 837 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Nawar and D Aron Adrenal incidentalomas -- a continuing management dilemma Endocr. Relat. Cancer, September 1, 2005; 12(3): 585 - 598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Terzolo, S. Bovio, A. Pia, P. A. Conton, G. Reimondo, C. Dall'Asta, D. Bemporad, A. Angeli, G. Opocher, M. Mannelli, et al. Midnight serum cortisol as a marker of increased cardiovascular risk in patients with a clinically inapparent adrenal adenoma Eur. J. Endocrinol., August 1, 2005; 153(2): 307 - 315. [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]
|
|
|
|
 |
|
 G. Mansmann, J. Lau, E. Balk, M. Rothberg, Y. Miyachi, and S. R. Bornstein The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management Endocr. Rev., April 1, 2004; 25(2): 309 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Copeland Management of the Clinically Inapparent Adrenal Mass Ann Intern Med, March 2, 2004; 140(5): 401 - 401. [Full Text] [PDF]
|
|
|
|
|
|
G. D. Braunstein and for the National Institutes of Health State-of-the Management of the Clinically Inapparent Adrenal Mass Ann Intern Med, March 2, 2004; 140(5): 401 - 402. [Full Text] [PDF]
|
|
|
|
|
|
J. W. Findling, H. Raff, and D. C. Aron The Low-Dose Dexamethasone Suppression Test: A Reevaluation in Patients with Cushing's Syndrome J. Clin. Endocrinol. Metab., March 1, 2004; 89(3): 1222 - 1226. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. La Cava, A. Imperiale, C. Olianti, G. R. Gheri, C. Ladu, M. Mannelli, and A. Pupi SPECT Semiquantitative Analysis of Adrenocortical 131I-6{beta}-Iodomethyl-Norcholesterol Uptake to Discriminate Subclinical and Preclinical Functioning Adrenal Incidentaloma J. Nucl. Med., July 1, 2003; 44(7): 1057 - 1064. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Angeli and M. Terzolo Adrenal Incidentaloma--A Modern Disease with Old Complications J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 4869 - 4871. [Full Text] [PDF]
|
|
| 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 |
