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

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Abstract

Purpose

Cushing syndrome (CS) is a well-known risk factor for cardiovascular morbidities. We aimed to evaluate endothelial and cardiovascular functions, endothelial mediators and pro-inflammatory cytokines in patients with CS before and after remission.

Methods

Adult patients with newly diagnosed endogenous CS were included. Metabolic [body mass index (BMI), glucose, and lipid values] and cardiovascular evaluation studies [24-h ambulatory blood pressure monitoring, carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and echocardiography] were performed, and endothelial mediators [asymmetric dimethyl arginine (ADMA) and endothelin-1 (ET-1)] and pro-inflammatory cytokines [interleukin-1β (IL-1β) and tumor necrosis factor-alpha (TNF-α)] were measured. Control group was matched in terms of age, gender, and BMIs.

Results

Twenty-five patients, mean age 40.60 ± 14.04 years, completed the study. Compared to controls (n = 20) mean arterial pressure (MAP) and CIMT were higher (p < 0.005 and p = 0.012, respectively), and FMD (p < 0.001) and mitral E/A ratio (p = 0.007) lower in the patients during active disease. Baseline serum ADMA, ET-1, and IL-1β were similar between the groups, while TNF-α was lower in the patients (p = 0.030). All patients were in complete remission 1 year following surgery. BMI, LDL cholesterol, serum total cholesterol, fasting plasma glucose, MAPs, and CIMT significantly decreased (p < 0.005), while there was no improvement in FMD (p = 0.11) following remission. There was no significant change in ADMA, IL-1β, and TNF-α levels, but ET-1 increased (p = 0.011).

Conclusions

Remission in CS improves some cardiovascular parameters. ADMA and ET-1 are not reliable markers for endothelial dysfunction in CS. Metabolic improvements may not directly reflect on serum concentrations of TNF-α and IL-1β following remission of CS.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by the Scientific Research Unit of Erciyes University under Project No. TTU-2013-4566.

Funding

This work was funded by the Scientific Research Unit of Erciyes University under Project No. TTU-2013-4566.

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Authors and Affiliations

  1. Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey

    A. Hacioglu, S. T. Firat, A. S. Caglar, Z. Karaca, F. Tanriverdi & K. Unluhizarci

  2. Department of Cardiology, Erciyes University Medical School, Kayseri, Turkey

    N. Kalay

  3. Department of Medical Biology, Erciyes University Medical School, Kayseri, Turkey

    S. Taheri

  4. Department of Neurosurgery, Erciyes University Medical School, Kayseri, Turkey

    A. Selcuklu

  5. Faculty of Medicine, Department of Endocrinology, Yeditepe University, Istanbul, Turkey

    F. Kelestimur

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Contributions

FK, ZK, KU, ST, and AH: contributed to conception and design of the study; AH, STF, ASC, ST, AS, NK, and FT: contributed to acquisition of data; ST: contributed to acquisition and analysis of laboratory test results; STF and AH: organized the database; AH: performed the statistics and wrote the first draft of the manuscript; AH, ZK, and NK: contributed to interpretation of data. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Z. Karaca.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

Approval was obtained from the ethics committee of Erciyes University Medical School (2013/155). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Hacioglu, A., Firat, S.T., Caglar, A.S. et al. Cardiovascular evaluation and endothelial dysfunction in Cushing syndrome following remission: a prospective study. J Endocrinol Invest 47, 645–653 (2024). https://doi.org/10.1007/s40618-023-02183-4

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  • DOI: https://doi.org/10.1007/s40618-023-02183-4

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