Kanzaki Akinori, Kadoya Manabu, Katayama Satoru, Koyama Hidenori
Department of Internal Medicine, Hyogo College of Medicine, Sasayama Medical Center, Sasayama 669-2321, Hyogo, Japan.
Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Nishinomiya 663-8131, Hyogo, Japan.
J Clin Med. 2022 Nov 28;11(23):7035. doi: 10.3390/jcm11237035.
The survival rate of adrenal Cushing syndrome patients has been greatly increased because of the availability of appropriate surgical and pharmacological treatments. Nevertheless, increased possibility of a heart attack induced by a cardiovascular event remains a major risk factor for the survival of affected patients. In experimental studies, hypercortisolemia has been found to cause cardiomyocyte hypertrophy via glucocorticoid receptor activation, including the possibility of cross talk among several hypertrophy signals related to cardiomyocytes and tissue-dependent regulation of 11β-hydroxysteroid dehydrogenase type 1. However, the factors are more complex in clinical cases, as both geometric and functional impairments leading to heart failure have been revealed, and their associations with a wide range of factors such as hypertension are crucial. In addition, knowledge regarding such alterations in autonomous cortisol secretion, which has a high risk of leading to heart attack as well as overt Cushing syndrome, is quite limited. When considering the effects of treatment, partial improvement of structural alterations is expected, while functional disorders are controversial. Therefore, whether the normalization of excess cortisol attenuates the risk related to cardiac hypertrophy has yet to be fully elucidated.
由于有了合适的手术和药物治疗方法，肾上腺库欣综合征患者的存活率大幅提高。然而，心血管事件引发心脏病发作的可能性增加仍然是影响患者存活的主要风险因素。在实验研究中，已发现高皮质醇血症通过糖皮质激素受体激活导致心肌细胞肥大，包括几种与心肌细胞相关的肥大信号之间存在相互作用以及11β - 羟类固醇脱氢酶1型的组织依赖性调节的可能性。然而，临床病例中的因素更为复杂，因为已揭示出导致心力衰竭的几何和功能损伤，并且它们与高血压等多种因素的关联至关重要。此外，关于自主性皮质醇分泌这种改变（其导致心脏病发作以及明显库欣综合征的风险很高）的知识相当有限。在考虑治疗效果时，预计结构改变会部分改善，而功能障碍则存在争议。因此，过量皮质醇的正常化是否能降低与心肌肥大相关的风险尚未完全阐明。
