Cardiovascular consequences of cortisol excess

Abstract

Cushing's syndrome is a consequence of primary or, more commonly, secondary oversecretion of cortisol. Cardiovascular disease is the major cause of morbidity and mortality in Cushing's syndrome, and excess risk remains even in effectively treated patients. The cardiovascular consequences of cortisol excess are protean and include, inter alia, elevation of blood pressure, truncal obesity, hyperinsulinemia, hyperglycemia, insulin resistance, and dyslipidemia. This review analyses the relationship of cortisol excess, both locally and at tissue level, to these cardiovascular risk factors, and to putative mechanisms for hypertension. Previous studies have examined correlations between cortisol, blood pressure, and other parameters in the general population and in Cushing's syndrome. This review also details changes induced by short-term cortisol administration in normotensive healthy men.

Comorbidades clínicas e psiquiátricas em pacientes com transtorno bipolar do tipo I

“…Dados de neuroimagem, por exemplo, mostram que há sobreposição dos circuitos neurais ligados à regulação do humor e do comportamento alimentar, como as conexões entre a amígdala e o córtex pré-frontal 25,26 . Além disso, a hiperatividade persistente do eixo hipotálamo-hipófise-adrenal em pacientes bipolares pode estar relacionada a elevação da pressão arterial, aumento de resistência à insulina e dislipidemia 27,28 . É importante mencionar que o uso de medicamentos psicotrópicos, particularmente os antipsicóticos atípicos, também está ligado a síndrome metabólica, aumento do apetite e preferência por alimentos doces, assim como redução da atividade física 29 .…”

Diurnal variation of endothelial function and arterial stiffness in hypertension

“…The simultaneous early morning increase in serum cortisol levels might be involved in these mechanisms, 26,39 whereas a late detrimental effect on endothelial function exerted by a combination of factors, such as increased blood pressure and triglycerides found in the evening, cannot be excluded. In regard to cortisol, an observation that argues against causality with FMD is that cortisol further decreases from noon to 2100 hours, whereas FMD remains unchanged, suggesting that cortisol changes are not linearly related with those of FMD.…”

Cortisol, dehydroepiandrosterone sulphate, their ratio and hypertension: evidence of associations in male veterans from the Vietnam Experience Study

“…First, glucocorticoid hypertension, such as in Cushing's syndrome is rare, reportedly affecting only one in 300-400 hypertensives at referral centres. 2 Second, exogenous cortisol administration has been consistently shown to result in an increase in blood pressure. [3][4][5][6] Third, glucocorticoids are being increasingly implicated in the regulation of blood pressure at several sites, including the vasculature, the kidneys and the brain.…”

“…Conditions characterised by excess cortisol secretion, such as Cushing's syndrome, are associated with hypertension, whereas impaired secretion of cortisol in Addison's disease is associated with severe hypotension, which is successfully managed by corticosteroid replacement. 1,2 Furthermore, experimental infusion of cortisol in normotensive men has been repeatedly shown to result in an increase in blood pressure. [3][4][5][6] However, the evidence that suggests that cortisol excess is a feature of population hypertension is less overwhelming.…”