Increased arterial rigidity in children affected by Cushing’s syndrome after successful surgical cure

Bassareo, Pier Paolo; Marras, Andrea Raffaele; Pasqualucci, Daniele; Mercuro, Giuseppe

doi:10.1017/s1047951110000727

Cited by 19 publications

(18 citation statements)

References 21 publications

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“…Notwithstanding this amelioration in cardiac morphology, the percentage of abnormal measurements remained in excess compared with controls, in particular relative to segmental measurements. In this context, a recent cross‐sectional study on children cured of Cushing’s syndrome revealed greater mass measurements some 4 years after surgery compared with matched controls 24 …”

Section: Discussionmentioning

confidence: 99%

Clinical relevance of cardiac structure and function abnormalities in patients with Cushing’s syndrome before and after cure

Toja

Branzi

Ciambellotti

et al. 2012

Clinical Endocrinology

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Section: Discussionmentioning

confidence: 99%

Clinical relevance of cardiac structure and function abnormalities in patients with Cushing’s syndrome before and after cure

Toja

Branzi

Ciambellotti

et al. 2012

Clinical Endocrinology

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“…DBP completely normalized in all patients within 3 months [25]. In contrast, after successful treatment of 23 children with CS, an Italian study found a persistent significant impairment in arterial distensibility and altered 24-h BP monitoring, compared to controls [119]. This suggests that while BP improves faster in young patients, who are somewhat protected from microvascular damage, an increased cardiovascular risk persists despite cortisol and BP normalization.…”

Section: Effect Of Treatment Of Cushing's Syndrome On Hypertensionmentioning

confidence: 99%

The hypertension of Cushing's syndrome

Isidori

Graziadio

Paragliola

et al. 2015

Journal of Hypertension

134

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Cushing's syndrome is associated with increased mortality, mainly due to cardiovascular complications, which are sustained by the common development of systemic arterial hypertension and metabolic syndrome, which partially persist after the disease remission. Cardiovascular diseases and hypertension associated with endogenous hypercortisolism reveal underexplored peculiarities. The use of exogenous corticosteroids also impacts on hypertension and cardiovascular system, especially after prolonged treatment. The mechanisms involved in the development of hypertension differ, whether glucocorticoid excess is acute or chronic, and the source endogenous or exogenous, introducing inconsistencies among published studies. The pleiotropic effects of glucocorticoids and the overlap of the several regulatory mechanisms controlling blood pressure suggest that a rigorous comparison of in-vivo and in-vitro studies is necessary to draw reliable conclusions. This review, developed during the first ‘Altogether to Beat Cushing's syndrome’ workshop held in Capri in 2012, evaluates the most important peculiarities of hypertension associated with CS, with a particular focus on its pathophysiology. A critical appraisal of most significant animal and human studies is compared with a systematic review of the few available clinical trials. A special attention is dedicated to the description of the clinical features and cardiovascular damage secondary to glucocorticoid excess. On the basis of the consensus reached during the workshop, a pathophysiology-oriented therapeutic algorithm has been developed and it could serve as a first attempt to rationalize the treatment of hypertension in Cushing's syndrome.

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“…The QKd technique has previously been validated in comparison to pulse wave velocity (19). Previous studies in pediatric patients have been performed as well (24,25). Because this interval is inversely correlated with pulse wave velocity, QKd measurement provides valuable information on arterial distensibility, as it is calculated using an arterial segment including the ascending aorta and a portion of the subclavian and brachial arteries (20).…”

Section: Introductionmentioning

confidence: 99%

Daily assessment of arterial distensibility in a pediatric population before and after smoking cessation

Bassareo¹,

Fanos²,

Crisafulli³

et al. 2014

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OBJECTIVES:Cigarette smoking is an important modifiable cardiovascular risk factor associated with increased stiffness of the large arteries in adulthood. This study aimed to 1) evaluate arterial distensibility and echocardiographic measures in adolescent smokers before and after participation in a successful smoking cessation program and to 2) compare the findings obtained with data from a control population of healthy non-smokers.METHODS:A total of 31 young smoking subjects (58.1% male; range: 11-18 years old; mean: 16.5±1.4 years old; mean tobacco consumption: 2.6±0.6 years) were examined before commencing and after taking part for at least 1 year in a smoking cessation program (mean: 1.4±0.3 years). Arterial stiffness was measured using the previously validated QKd100-60 method. Twenty-four-hour ambulatory blood pressure monitoring and transthoracic echocardiography were also performed.RESULTS:(Smokers before abuse cessation vs. smokers after abuse cessation) systolic blood pressure: p<0.004; diastolic blood pressure: p<0.02; mean blood pressure: p<0.01; QKd100-60 value: 183±5 vs. 196±3 msec, p<0.009; p = ns for all echocardiographic parameters. (Smokers after abuse cessation vs. controls) systolic blood pressure: p<0.01; diastolic blood pressure: p<0.03; mean blood pressure: p<0.02; QKd100-60 value: 196±3 vs. 203±2 msec, p<0.04; p<0.02, p<0.01, and p<0.05 for the interventricular septum, posterior wall, and left ventricular mass, respectively.CONCLUSIONS:Despite successful participation in a smoking cessation program, arterial distensibility improved but did not normalize. This finding underlines the presence of the harmful effect of arterial rigidity in these individuals, despite their having quit smoking and their young ages, thus resulting in the subsequent need for a lengthy follow-up period.

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Increased arterial rigidity in children affected by Cushing’s syndrome after successful surgical cure

Cited by 19 publications

References 21 publications

Clinical relevance of cardiac structure and function abnormalities in patients with Cushing’s syndrome before and after cure

Clinical relevance of cardiac structure and function abnormalities in patients with Cushing’s syndrome before and after cure

The hypertension of Cushing's syndrome

Daily assessment of arterial distensibility in a pediatric population before and after smoking cessation

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