Johannsson Gudmundur, Ragnarsson Oskar
Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Front Horm Res. 2014;43:33-44. doi: 10.1159/000360556. Epub 2014 Jun 10.
Cortisol in man is essential for life. Excess cortisol as in Cushing's syndrome and during pharmacological glucocorticoid (GC) therapy is associated with increased cardiovascular morbidity and mortality. Recent data from patients with adrenal insufficiency (AI) have demonstrated that currently used replacement regimens are associated with a poor cardiovascular outcome. In particular, a more than doubled vascular mortality rate has been observed in patients with primary AI. The unphysiological GC replacement, both in terms of the total daily dose and the pattern of delivery, may explain this poor outcome together with an inadequate treatment during an intercurrent illness. The mechanism may be both an induction of classical metabolic risk factors for vascular disease, such as obesity and hypertension, but also an unphysiological cortisol exposure to the vascular endothelium and the immune system that may induce an accelerated atherosclerotic process. This review summarizes some of the cardiovascular data associated with GC excess and outcome data in patients with AI. Studies that have compared various regimens for replacement therapy will be addressed and recent developments that may improve outcome in patients with AI will be discussed.
皮质醇对人类的生命至关重要。库欣综合征患者以及接受药理糖皮质激素（GC）治疗期间出现的皮质醇过量与心血管疾病发病率和死亡率增加有关。肾上腺功能不全（AI）患者的最新数据表明，目前使用的替代治疗方案与不良心血管结局相关。特别是，原发性AI患者的血管死亡率增加了一倍多。无论是每日总剂量还是给药方式，非生理性的GC替代治疗可能与这种不良结局有关，同时在并发疾病期间治疗不足也可能导致这种情况。其机制可能既是诱导血管疾病的经典代谢危险因素，如肥胖和高血压，也是非生理性的皮质醇暴露于血管内皮和免疫系统，这可能会加速动脉粥样硬化进程。本综述总结了一些与GC过量相关的心血管数据以及AI患者的结局数据。将讨论比较各种替代治疗方案的研究，并探讨可能改善AI患者结局的最新进展。
