Morbach Caroline, Detomas Mario, Sahiti Floran, Hoffmann Kristina, Kroiss Matthias, Gelbrich Götz, Frantz Stefan, Hahner Stefanie, Heuschmann Peter Ulrich, Fassnacht Martin, Störk Stefan, Deutschbein Timo
Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center Würzburg, 97078 Würzburg, Germany.
Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany.
Eur J Endocrinol. 2024 Nov 27;191(6):604-613. doi: 10.1093/ejendo/lvae145.
Cushing's syndrome (CS) results in increased cardiovascular (CV) morbidity and mortality. Subtype-specific differences and possible reversibility after biochemical cure are not well investigated.
Prospective cohort study evaluating the CV status in different forms of endogenous cortisol excess.
Patients with overt CS (n = 40, 47 ± 13 years, 75% women; 18 pituitary, 13 adrenal, and 9 ectopic), biochemically cured CS (n = 56, 53 ± 12 years, 79% women; 30 pituitary, 21 adrenal, and 5 ectopic), and adrenal incidentalomas with mild autonomous cortisol secretion (MACS) (n = 18, 62 ± 11 years, 56% women) underwent comprehensive biochemical, metabolic, and CV assessment. Results were compared with a representative sample of the general population of Würzburg (n = 4965, 55 ± 12 years, 52% women).
Overt CS was associated with left ventricular (LV) remodeling along with hypertrophy and impaired longitudinal systolic/diastolic function at echocardiography. In 20 CS patients followed for a median of 8 (quartiles: 6, 11) months after biochemical remission, hypertension, and hyperglycemia were better controlled, while cardiac alterations only partially improved. Patients with previous CS (median time of biochemical remission: 95 [36, 201] months) had worse diastolic function than the general population (LV relaxation velocity e' 0.08 [0.07, 0.10] ms-1 vs 0.10 [0.08, 0.12] ms-1, P < .001). In MACS, cardiac remodeling was even more pronounced than in individuals with metabolic syndrome.
In patients with overt CS, cured CS, and MACS, we found a sizable and significant deviation from the general population mean regarding cardiac structure and function. Even mild cortisol excess is associated with glucocorticoid-induced cardiac alterations, which appear to persist despite long-term biochemical remission.
库欣综合征（CS）会导致心血管（CV）发病率和死亡率增加。目前对其亚型特异性差异以及生化治愈后的可能可逆性研究尚不充分。
一项前瞻性队列研究，评估不同形式内源性皮质醇增多症患者的心血管状况。
对显性CS患者（n = 40，年龄47±13岁，75%为女性；18例垂体性、13例肾上腺性、9例异位性）、生化治愈的CS患者（n = 56，年龄53±12岁，79%为女性；30例垂体性、21例肾上腺性、5例异位性）以及轻度自主性皮质醇分泌的肾上腺偶发瘤（MACS）患者（n = 18，年龄62±11岁，56%为女性）进行全面的生化、代谢和心血管评估。将结果与维尔茨堡普通人群的代表性样本（n = 4965，年龄55±12岁，52%为女性）进行比较。
显性CS与左心室（LV）重构相关，伴有肥厚以及超声心动图检查显示纵向收缩/舒张功能受损。在20例CS患者生化缓解后中位随访8（四分位数：6，11）个月时，高血压和高血糖得到更好控制，但心脏改变仅部分改善。既往有CS的患者（生化缓解中位时间：95 [36，201]个月）舒张功能比普通人群更差（左心室舒张速度e' 0.08 [0.07，0.10] ms-1 vs 0.10 [0.08，0.12] ms-1，P <.001）。在MACS患者中，心脏重构比代谢综合征患者更为明显。
在显性CS、治愈的CS和MACS患者中，我们发现其心脏结构和功能与普通人群均值存在相当大且显著的偏差。即使是轻度皮质醇增多也与糖皮质激素诱导的心脏改变相关，而且这些改变似乎在长期生化缓解后仍然持续存在。
