Cardiac characteristics and postoperative courses in Cushing's syndrome

Sugihara, Norihiko; Shimizu, Masami; Kita, Yoshihito; Shimizu, Kuniyoshi; Ino, Hidekazu; Miyamori, Isamu; Nakabayashi, Hajime; Takeda, Ryoyu

doi:10.1016/0002-9149(92)90904-d

Cited by 60 publications

(39 citation statements)

References 16 publications

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“…These results suggest that Cushing's syndrome is associated with left ventricular hypertrophy with a poor geometric pattern. Although Sugihara et al [9] demonstrated that ASH is the characteristic pattern of hypertrophy in Cushing's syndrome, none of the patients in our study showed that type of hypertrophy.…”

Section: Discussioncontrasting

confidence: 90%

“…Hypercortisolism, the major pathophysiological condition in Cushing's syndrome, has been suggested to contribute to cardiac hypertrophy [9,10,14]. Duprez et al [39] have shown evidence of a significant relationship between cortisol production and dent factors determining eF and LVMI, eF, and LVMI, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The ejection fraction (eF) was calculated using the following formula: (LVDd 2 -LVDs 2 )/ LVDd 2 ×100 function in Cushing's syndrome. Hypertension and impaired glucose and lipid metabolism due to chronic hypercortisolism and the direct effects of cortisol on the heart have been reported as risks for cardiovascular complications [9,10] …”

Section: Echocardiographymentioning

confidence: 99%

“…Cardiac dysfunction is one of the most important cardiovascular complications affecting mortality. Cardiac hypertrophy [8][9][10][11] and congestive heart failure [3,[12][13][14] are the major forms of cardiac dys-0900 h with a mercury sphygmomanometer after at least 30 minutes spine-position and diagnosis of hypertension was defined according to the Guideline of JnC7. blood biochemistry was measured at the time of diagnosis in patients without heart failure and before administration of diuretics in the patients with heart failure.…”

mentioning

confidence: 99%

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Hypokalemia, Diabetes Mellitus, and Hypercortisolemia are the Major Contributing Factors to Cardiac Dysfunction in Adrenal Cushing's Syndrome

et al. 2009

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Abstract. Although cardiovascular complications are the major determinant of the prognosis of Cushing's syndrome (CS), factors contributing to the cardiovascular lesions are still unclear. We investigated clinical factors determining cardiac function in patients with adrenal CS. Fifty patients with adrenal CS were studied. Patients were divided into 3 groups based on their NYHA classification and electrocardiographic (ECG) findings: group A with NYHA grade 0 and normal eCg, group b with nyHA grade I and abnormal eCg, and group C with nyHA grade II or higher. Clinical and echocardiographic findings were compared between the groups. Heart failure of grade I or higher was seen in 40% and grade II or higher was seen in 8% of the patients. Age, HbA1c, and prevalence of diabetes mellitus were positively correlated and serum potassium levels were negatively correlated with the severity of cardiac dysfunction. Decreased ejection fraction (EF) and the ratio of the peak to late transmittal filling velocities (E/A), and increased left ventricular mass index (LVMI) were frequently observed. Multivariate analysis demonstrated that serum potassium and HbA1c levels were independent factors contributing to eF, while serum potassium and cortisol levels were independent factors contributing to LVMI. These results clearly demonstrated that hypokalemia, diabetes mellitus, and hypercortisolemia are the major contributing factors to cardiac dysfunction in adrenal CS. Strict control of these conditions is warranted for the prevention of cardiac dysfunction in adrenal CS.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Echocardiographymentioning

confidence: 99%

mentioning

confidence: 99%

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Hypokalemia, Diabetes Mellitus, and Hypercortisolemia are the Major Contributing Factors to Cardiac Dysfunction in Adrenal Cushing's Syndrome

et al. 2009

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“…Several previous reports have evaluated the structural characteristics of the left ventricle in patients with Cushing's syndrome (14,15). These studies revealed left ventricular hypertrophy to be more severe and more frequent in Cushing's syndrome patients than in essential or other secondary hypertension patients.…”

Section: Discussionmentioning

confidence: 99%

Dilated Cardiomyopathy as a Presenting Feature of Cushing's Syndrome

et al. 2013

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Cardiovascular complications, including cardiomegaly, myocardial ischemia and left ventricular hypertrophy, are some of the major determinants of the mortality rate in patients with Cushing's syndrome. We herein report the case of a patient with Cushing's syndrome caused by an adrenal adenoma who presented with congestive heart failure secondary to dilated cardiomyopathy. Follow-up echocardiography showed a marked improvement in the left ventricular cardiac function, and the plasma B-type natriuretic peptide (BNP) levels regressed after successful treatment. "Reversible" dilated cardiomyopathy is rarely associated with Cushing's syndrome; however, it should be recognized. Administering appropriate treatment in a timely manner can reverse this cardiomyopathy along with the other symptoms of Cushing's syndrome. Case ReportA 67-year-old woman was admitted with a refractory case of a burn on her left leg and hyperglycemia. She had been diagnosed with type 2 diabetes mellitus and hypertension seven years before her evaluation at our institution. On physical examination, she exhibited features typical of Cushing's syndrome, including a moon face, buffalo hump, truncal obesity and proximal muscle weakness. Her skin was atrophic, and she had purpura on her arm and legs. Her body mass index (BMI) was 34.3 kg/m 2 , her blood pressure was 173/116 mmHg and arterial blood gases showed hypoxia (pO2 50.2 mmHg, pCO2 46.8 mmHg, HCO3 -37.2 mmol/L and pH 7.5). The laboratory findings showed hypokalemia (K 3.1 mEq/L) and hyperglycemia (a fasting blood glucose level of 165 mg/mL, HbA1c 8.7%) ( Table 1). She had diabetes mellitus with simple retinopathy and early nephropathy. Her blood glucose levels were elevated in spite of treatment with a sulfonylurea and an α-glucosidase inhibitor (glibenclamide: 5 mg and acarbose: 100 mg). After admission, we started insulin injection therapy instead of oral administration. An electrocardiogram (ECG) showed RV5+SV1 35 mm, corresponding to left ventricle enlargement. The chest X-ray findings revealed cardiomegaly (cardiothoracic ratio (CTR): 66.1%) and were consistent with left cardiac failure. A transthoracic echocardiogram (ultrasound cardiography: UCG) revealed a dilated left ventricle (left ventricular end-diastolic diameter [LVDd]: 56 mm, left ventricular end-systolic diameter [LVDs]: 46 mm) and a left ventricle ejection fraction (LVEF) of 36% (Table 1) with an interventricular septum thickness (IVSt) of 13 mm, indicating mild hypertrophy. Cardiac catheterization confirmed dilated cardiomyopathy and severe ventricular dysfunction, with an LVEF of 18% and characteristic findings on a myocardial biopsy (Fig. 1). No coronary disease was detected. All serologies for myocarditis were negative. The level of B-type natriuretic peptide (BNP) was markedly elevated (1,746.1 pg/mL, as shown in Table 2). The 24-hour urinary free cortisol level was 249 μg/day (687.2 nmol, creatinine value: 4.2 mmol/24 hours). There was a loss of diurnal variation without suppression of the serum cortisol levels...

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Hypertrophic Cardiomyopathy During Corticotropin Therapy for Infantile Spasms

Bobele

Ward²

1993

Am J Dis Child

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Cardiac characteristics and postoperative courses in Cushing's syndrome

Cited by 60 publications

References 16 publications

Hypokalemia, Diabetes Mellitus, and Hypercortisolemia are the Major Contributing Factors to Cardiac Dysfunction in Adrenal Cushing's Syndrome

Hypokalemia, Diabetes Mellitus, and Hypercortisolemia are the Major Contributing Factors to Cardiac Dysfunction in Adrenal Cushing's Syndrome

Dilated Cardiomyopathy as a Presenting Feature of Cushing's Syndrome

Hypertrophic Cardiomyopathy During Corticotropin Therapy for Infantile Spasms

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