Increased Cardiovascular Risk in Patients with Adrenal Insufficiency: A Short Review

Abstract

Cardiovascular disease (CVD) is the most common cause of death in the world. Recent studies have shown an association between adrenal insufficiency (AI) and increased cardiovascular risk (CVR). Patients with AI receive glucocorticoid (GC) replacement therapy which can lead to varying levels of blood cortisol. It was shown that these imbalances in blood cortisol may lead to a higher prevalence of coronary heart disease, major adverse coronary events, and increased mortality. GC substitution is essential in the treatment of AI without which the disease has been shown to be fatal. The most frequently used GC formula for replacement therapy is hydrocortisone (HC). There is no uniform opinion on hydrocortisone replacement therapy. Alternative GC such as prednisolone is also in use. Overreplacement of GC may lead to adverse effects including obesity, high blood pressure, and hyperglycaemia. Outcome may vary between primary and secondary AI mainly due to differences in the renin-angiotensin-aldosterone system (RAAS). Furthermore, decreased blood levels of cortisol may lead to a compensatory secretion of inflammatory mediators such as Interleukin-1 (IL-1), Interleukin-6 (IL-6), and/or tumor-necrosis factor (TNF). Physicians and patients should be properly educated about the increased risk of CVD in patients with AI.

Association of adrenal insufficiency with patient-oriented health-care outcomes in adult medical inpatients

“…Due to long-term excess of glucocorticoid exposure, patients with adrenal insufficiency are at increased risk of developing comorbid conditions such as obesity, diabetes mellitus, hypertension, and depression (10). These comorbidities strongly contribute to an increased cardiovascular risk profile (20,21). Against this background we used a propensity score matching taking all relevant and documented comorbidities into account achieving well-balanced patient characteristics when compared to matched controls, in order to minimize possible confounding on the investigated outcomes.…”

Pleurotus albidus Modulates Mitochondrial Metabolism Disrupted by Hyperglycaemia in EA.hy926 Endothelial Cells

“…This fact is associated with the generation, mainly in mitochondrial complex I (NADH: ubiquinone oxidoreductase) and III (Ubiquinol: cytochrome c oxidoreductase), of the superoxide anion radical ( • O 2 − ) [ 5 ]. An excess of • O 2 − leads to H 2 O 2 formation and oxidative stress with damage to lipids, proteins and DNA, cell dysfunction, and apoptosis, which are important factors in the pathophysiology of diabetes and its complications [ 3 , 6 , 7 ]. Therefore, in recent years several studies have investigated the effect of phenolic compounds that specifically reduce ROS.…”

Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency

“…10,11 Underdosed regimens generate metabolic disturbances, 12–15 whereas overdosed ones induce hypercortisolism-related anomalies such as impaired glucose metabolism, insulin resistance, obesity, and hypertension. 16–19 In addition, a recent review 20 has outlined that both temporary over- and underdosed regimens greatly increase the risk for cerebrovascular diseases. Our review aims to describe glucocorticoid replacement therapy (GRT) in both pediatric and adult chronic AI, and to propose a new prescription regimen of GRT in adults.…”