Magiakou M A, Mastorakos G, Zachman K, Chrousos G P
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
J Clin Endocrinol Metab. 1997 Jun;82(6):1734-8. doi: 10.1210/jcem.82.6.3985.
Approximately half of children and adolescents with Cushing's syndrome develop hypertension. To examine the role of hypercortisolism in the pathogenesis of hypertension in young patients and to establish its reversibility, we studied 31 hypertensive children and adolescents with Cushing's syndrome (systolic, diastolic, and/or mean blood pressure more than 2 SD U for age and sex) from a total of 63 patients before, and for a period of 1 yr after surgical cure. Preoperatively, 93.5%, 42%, and 45% of these patients presented with an increase of the systolic, diastolic, and mean blood pressure, respectively. The systolic blood pressure remained increased in 30.7%, 15.8%, and 5.5% of patients at 3, 6, and 12 months after surgical cure, respectively. The diastolic and mean blood pressure completely normalized by 3 months after surgical cure. A significant, positive correlation was observed between the systolic blood pressure and the duration of the disease, but no correlation was seen with the 24-h urinary free cortisol values and/or the patients' body mass indices. The lack of correlation between 24-h urinary free cortisol values and blood pressure suggests that hypercortisolism influences blood pressure through multiple pathways. The positive correlation between the systolic blood pressure and the duration of the disease points towards the deleterious effects of prolonged hypercortisolism and the significance of early diagnosis and treatment. The fact that the blood pressure normalized within a year from the correction of hypercortisolism suggests that, as a rule, young patients with hypercortisolism do not develop essential hypertension.
约半数患有库欣综合征的儿童和青少年会出现高血压。为研究高皮质醇血症在年轻患者高血压发病机制中的作用并确定其可逆性，我们对63例患者中的31例患有库欣综合征的高血压儿童和青少年（收缩压、舒张压和/或平均血压超过年龄和性别的2个标准差单位）进行了术前及手术治愈后1年的研究。术前，这些患者中分别有93.5%、42%和45%的收缩压、舒张压和平均血压升高。手术治愈后3个月、6个月和12个月时，分别有30.7%、15.8%和5.5%的患者收缩压仍升高。手术治愈后3个月时舒张压和平均血压完全恢复正常。收缩压与病程之间存在显著正相关，但与24小时尿游离皮质醇值和/或患者体重指数无相关性。24小时尿游离皮质醇值与血压之间缺乏相关性表明，高皮质醇血症通过多种途径影响血压。收缩压与病程之间的正相关表明长期高皮质醇血症的有害影响以及早期诊断和治疗的重要性。高皮质醇血症纠正后一年内血压恢复正常这一事实表明，一般来说，患有高皮质醇血症的年轻患者不会发展为原发性高血压。
