Abstract
Long-standing exposure to endogenous cortisol excess is associated with high cardiovascular
risk. The aim of our study was to investigate arterial stiffness, which has been recognized
as an independent predictor of adverse cardiovascular outcome, in a group of patients
with Cushing’s syndrome. Twenty-four patients with Cushing’s syndrome (3 males, mean
age 49±13 years; 20 pituitary-dependent Cushing’s disease and 4 adrenal adenoma) underwent
24-h ambulatory blood pressure monitoring (ABPM) and evaluation of cardiovascular
risk factors. The Ambulatory Arterial Stiffness Index (AASI) and symmetric AASI (sAASI)
were derived from ABPM tracings. Cushing patients were divided into 8 normotensive
(NOR-CUSH) and 16 hypertensive (HYP-CUSH) patients, and were compared with 8 normotensive
(NOR-CTR) and 16 hypertensive (HYP-CTR) control subjects, matched for demographic
characteristics, 24-h ABPM and cardiometabolic risk factors. The AASI and sAASI indexes
were significantly higher in Cushing patients than in controls, either in the normotensive
(p=0.048 for AASI and p=0.013 for sAASI) or in the hypertensive (p=0.004 for AASI
and p=0.046 for sAASI) group. No difference in metabolic parameters was observed between
NOR-CUSH and NOR-CTR or between HYP-CUSH and HYP-CTR groups. AASI and sAASI were both
correlated with urinary cortisol in patients with endogenous hypercortisolism (Spearman’s
rho=0.40, p=0.05, and 0.61, p=0.003, respectively), while no correlation was found
in controls. Both AASI and sAASI are increased in Cushing syndrome, independent of
BP elevation, and may represent an additional cardiovascular risk factor in this disease.
The role of excess cortisol in arterial stiffness has to be further clarified.
Key words
arterial stiffness - ambulatory blood pressure monitoring - Cushing’s syndrome