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Song M, Choi DB, Im JS, Song YN, Kim JH, Lee H, An J, Kim A, Choi H, Kim JC, Han C, Jeon YK, Kim SJ, Woo DH. Modeling acute myocardial infarction and cardiac fibrosis using human induced pluripotent stem cell-derived multi-cellular heart organoids. Cell Death Dis 2024; 15:308. [PMID: 38693114 PMCID: PMC11063052 DOI: 10.1038/s41419-024-06703-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
Heart disease involves irreversible myocardial injury that leads to high morbidity and mortality rates. Numerous cell-based cardiac in vitro models have been proposed as complementary approaches to non-clinical animal research. However, most of these approaches struggle to accurately replicate adult human heart conditions, such as myocardial infarction and ventricular remodeling pathology. The intricate interplay between various cell types within the adult heart, including cardiomyocytes, fibroblasts, and endothelial cells, contributes to the complexity of most heart diseases. Consequently, the mechanisms behind heart disease induction cannot be attributed to a single-cell type. Thus, the use of multi-cellular models becomes essential for creating clinically relevant in vitro cell models. This study focuses on generating self-organizing heart organoids (HOs) using human-induced pluripotent stem cells (hiPSCs). These organoids consist of cardiomyocytes, fibroblasts, and endothelial cells, mimicking the cellular composition of the human heart. The multi-cellular composition of HOs was confirmed through various techniques, including immunohistochemistry, flow cytometry, q-PCR, and single-cell RNA sequencing. Subsequently, HOs were subjected to hypoxia-induced ischemia and ischemia-reperfusion (IR) injuries within controlled culture conditions. The resulting phenotypes resembled those of acute myocardial infarction (AMI), characterized by cardiac cell death, biomarker secretion, functional deficits, alterations in calcium ion handling, and changes in beating properties. Additionally, the HOs subjected to IR efficiently exhibited cardiac fibrosis, displaying collagen deposition, disrupted calcium ion handling, and electrophysiological anomalies that emulate heart disease. These findings hold significant implications for the advancement of in vivo-like 3D heart and disease modeling. These disease models present a promising alternative to animal experimentation for studying cardiac diseases, and they also serve as a platform for drug screening to identify potential therapeutic targets.
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Affiliation(s)
- Myeongjin Song
- Department of Commercializing Organoid Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Da Bin Choi
- Department of Commercializing Organoid Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Jeong Suk Im
- Department of Commercializing Organoid Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Ye Na Song
- Department of Commercializing Organoid Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Ji Hyun Kim
- Department of Commercializing Organoid Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Hanbyeol Lee
- Centre for Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC, 3168, Australia
| | - Jieun An
- Department of Commercializing iPSC Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Ami Kim
- Department of Commercializing iPSC Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Hwan Choi
- Department of Commercializing iPSC Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Joon-Chul Kim
- Department of Commercializing Organoid Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Choongseong Han
- Department of Commercializing Organoid Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
- Department of Commercializing iPSC Technology, NEXEL Co., Ltd., Seoul, 07802, Korea
| | - Young Keul Jeon
- Department of Physiology, Seoul National University College of Medicine, Seoul, 03080, Korea
- Ischemic/Hypoxic Disease Institute, Seoul National University, College of Medicine, Seoul, 03080, Korea
| | - Sung Joon Kim
- Department of Physiology, Seoul National University College of Medicine, Seoul, 03080, Korea
- Ischemic/Hypoxic Disease Institute, Seoul National University, College of Medicine, Seoul, 03080, Korea
| | - Dong-Hun Woo
- Department of Commercializing Organoid Technology, NEXEL Co., Ltd., Seoul, 07802, Korea.
- Department of Commercializing iPSC Technology, NEXEL Co., Ltd., Seoul, 07802, Korea.
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Bavaresco A, Mazzeo P, Lazzara M, Barbot M. Adipose tissue in cortisol excess: What Cushing's syndrome can teach us? Biochem Pharmacol 2024; 223:116137. [PMID: 38494065 DOI: 10.1016/j.bcp.2024.116137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Endogenous Cushing's syndrome (CS) is a rare condition due to prolonged exposure to elevated circulating cortisol levels that features its typical phenotype characterised by moon face, proximal myopathy, easy bruising, hirsutism in females and a centripetal distribution of body fat. Given the direct and indirect effects of hypercortisolism, CS is a severe disease burdened by increased cardio-metabolic morbidity and mortality in which visceral adiposity plays a leading role. Although not commonly found in clinical setting, endogenous CS is definitely underestimated leading to delayed diagnosis with consequent increased rate of complications and reduced likelihood of their reversal after disease control. Most of all, CS is a unique model for systemic impairment induced by exogenous glucocorticoid therapy that is commonly prescribed for a number of chronic conditions in a relevant proportion of the worldwide population. In this review we aim to summarise on one side, the mechanisms behind visceral adiposity and lipid metabolism impairment in CS during active disease and after remission and on the other explore the potential role of cortisol in promoting adipose tissue accumulation.
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Affiliation(s)
- Alessandro Bavaresco
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Pierluigi Mazzeo
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Martina Lazzara
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Mattia Barbot
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy.
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Moustaki M, Markousis-Mavrogenis G, Vryonidou A, Paschou SA, Mavrogeni S. Cardiac disease in Cushing's syndrome. Emphasis on the role of cardiovascular magnetic resonance imaging. Endocrine 2024; 83:548-558. [PMID: 38129722 DOI: 10.1007/s12020-023-03623-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Cushing's Syndrome (CS) is associated with increased cardiovascular morbidity and mortality. In endogenous CS, cardiovascular mortality remains increased for up to 15 years post remission of hypercortisolism. Similarly, patients with exogenous CS have 4-fold increased incidence of cardiovascular events, regardless of pre-existing cardiovascular disease (CVD). OBJECTIVE To present the pathophysiology, prognosis, clinical and imaging phenotype of cardiac disease in CS. METHODS A Pubmed search for cardiac disease in CS over the last 20 years was conducted using combinations of relevant terms. Preclinical and clinical studies, as well as review papers reporting on subclinical heart failure (HF), cardiomyopathy, coronary heart disease (CHD), and cardiovascular imaging were selected. RESULTS Cardiac disease in CS is associated with direct mineralocorticoid and glucocorticoid receptor activation, increased responsiveness to angiotensin II, ectopic epicardial adiposity, arterial stiffness and endothelial dysfunction, as well as with diabetes mellitus, hypertension, hyperlipidemia, obesity and prothrombotic diathesis. Subclinical HF and cardiomyopathy are principally related to direct glucocorticoid (GC) effects and markedly improve or regress post hypercortisolism remission. In contrast, CHD is related to both direct GC effects and CS comorbidities and persists post cure. In patients without clinical evidence of CVD, echocardiography and cardiac magnetic resonance (CMR) imaging reveal left ventricular hypertrophy, fibrosis, diastolic and systolic dysfunction, with the latter being underestimated by echocardiography. Finally, coronary microvascular disease is encountered in one third of cases. CONCLUSION Cardiovascular imaging is crucial in evaluation of cardiac involvement in CS. CMR superiority in terms of reproducibility, operator independency, unrestricted field of view and capability of tissue characterisation makes this modality ideal for future studies.
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Affiliation(s)
- Melpomeni Moustaki
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, Athens, Greece.
| | - George Markousis-Mavrogenis
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophie Mavrogeni
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
- Onassis Cardiac Surgery Center, Athens, Greece
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Role of cardiovascular magnetic resonance in the clinical evaluation of left ventricular hypertrophy: a 360° panorama. Int J Cardiovasc Imaging 2022; 39:793-809. [PMID: 36543912 DOI: 10.1007/s10554-022-02774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
Left ventricular hypertrophy (LVH) is a frequent imaging finding in the general population. In order to identify the precise etiology, a comprehensive diagnostic approach should be adopted, including the prevalence of each entity that may cause LVH, family history, clinical, electrocardiographic and imaging findings. By providing a detailed evaluation of the myocardium, cardiovascular magnetic resonance (CMR) has assumed a central role in the differential diagnosis of left ventricular hypertrophy, with the technique of parametric imaging allowing more refined tissue characterization. This article aims to establish a parallel between pathophysiological features and imaging findings through the broad spectrum of LVH entities, emphasizing the role of CMR in the differential diagnosis.
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Januszewicz A, Mulatero P, Dobrowolski P, Monticone S, Van der Niepen P, Sarafidis P, Reincke M, Rexhaj E, Eisenhofer G, Januszewicz M, Kasiakogias A, Kreutz R, Lenders JW, Muiesan ML, Persu A, Agabiti-Rosei E, Soria R, Śpiewak M, Prejbisz A, Messerli FH. Cardiac Phenotypes in Secondary Hypertension. J Am Coll Cardiol 2022; 80:1480-1497. [DOI: 10.1016/j.jacc.2022.08.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
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Clayton RN. Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality. J Neuroendocrinol 2022; 34:e13175. [PMID: 35764311 PMCID: PMC9541180 DOI: 10.1111/jne.13175] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Richard N. Clayton
- PlymouthUK (no current academic affiliation, formerly University of Keele, Stoke on Trent, UK)
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Tadic M, Sala C, Carugo S, Mancia G, Grassi G, Cuspidi C. Left ventricular global longitudinal strain in secondary hypertension: A meta-analysis of echocardiographic studies. Eur J Intern Med 2022; 96:81-89. [PMID: 34711473 DOI: 10.1016/j.ejim.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022]
Abstract
AIM Information on systolic dysfunction, as assessed by left ventricular (LV) mechanics in secondary hypertension is still largely limited. We performed a systematic meta- analysis of 2D/3D speckle tracking studies in order to provide an updated comprehensive information on this topic. METHODS The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search for articles published from the inception up to March 31st 2021. Studies were identified by using MeSH terms and crossing the following search items: "myocardial strain" "left ventricular mechanics", "speckle tracking echocardiography", "systolic dysfunction", "hypertensive heart disease", "left ventricular hypertrophy", "secondary hypertension", "primary aldosteronism", "pheochromocytoma", "Cushing disease", "renal artery stenosis". RESULTS On the whole, 515 patients with secondary hypertension (169 pheochromocytoma, 165 primary aldosteronism, 144 renal artery stenosis and 37 Cushing's syndrome) and 601 essential hypertensive patients from 11 studies were considered. Pooled ejection fraction (EF) was similar in essential hypertensive controls and in patients with secondary hypertension (SMD 0.12±0.06, CI: 0.001/0.25, p=0.05). Of note, EF was higher in patients with pheochromocytoma than in essential hypertensives (0.50±0.11, CI: 0.27/0.73, p<0.001). In contrast, pooled GLS was impaired in patients with secondary hypertension compared to their essential hypertensive counterparts (SMD 0.83±0.26, CI: 0.32/1.30, p< 0.001). CONCLUSIONS The present meta-analysis adds a new piece of evidence by showing that GLS performs better than EF in identifying systolic dysfunction in the setting of secondary hypertension. In particular, this is true in patients with pheochromocytoma in whom conventional EF suggests a normal or even super-normal systolic function.
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Affiliation(s)
- Marijana Tadic
- University Hospital "Dr. Dragisa Misovic - Dedinje" Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Wolf P, Marty B, Bouazizi K, Kachenoura N, Piedvache C, Blanchard A, Salenave S, Prigent M, Jublanc C, Ajzenberg C, Droumaguet C, Young J, Lecoq AL, Kuhn E, Agostini H, Trabado S, Carlier PG, Fève B, Redheuil A, Chanson P, Kamenický P. Epicardial and Pericardial Adiposity Without Myocardial Steatosis in Cushing Syndrome. J Clin Endocrinol Metab 2021; 106:3505-3514. [PMID: 34333603 DOI: 10.1210/clinem/dgab556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Cardiovascular disease is the leading cause of death in patients with Cushing syndrome. Cortisol excess and adverse metabolic profile could increase cardiac fat, which can subsequently impair cardiac structure and function. OBJECTIVE We aimed to evaluate cardiac fat mass and distribution in patients with Cushing syndrome. METHODS In this prospective, cross-sectional study, 23 patients with Cushing syndrome and 27 control individuals of comparable age, sex, and body mass index were investigated by cardiac magnetic resonance imaging and proton spectroscopy. Patients were explored before and after biochemical disease remission. Myocardial fat measured by the Dixon method was the main outcome measure. The intramyocardial triglyceride/water ratio measured by spectroscopy and epicardial and pericardial fat volumes were secondary outcome measures. RESULTS No difference was found between patients and controls in intramyocardial lipid content. Epicardial fat mass was increased in patients compared to controls (30.8 g/m2 [20.4-34.8] vs 17.2 g/m2 [13.1-23.5], P < .001). Similarly, pericardial fat mass was increased in patients compared to controls (28.3 g/m2 [17.9-38.0] vs 11.4 g/m2 [7.5-19.4], P = .003). Sex, glycated hemoglobin A1c, and the presence of hypercortisolism were independent determinants of epicardial fat. Pericardial fat was associated with sex, impaired glucose homeostasis and left ventricular wall thickness. Disease remission decreased epicardial fat mass without affecting pericardial fat. CONCLUSION Intramyocardial fat stores are not increased in patients with Cushing syndrome, despite highly prevalent metabolic syndrome, suggesting increased cortisol-mediated lipid consumption. Cushing syndrome is associated with marked accumulation of epicardial and pericardial fat. Epicardial adiposity may exert paracrine proinflammatory effects promoting cardiomyopathy.
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Affiliation(s)
- Peter Wolf
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
- Medical University of Vienna, Department of Internal Medicine III, Division of Endocrinology and Metabolism, 1090 Vienna, Austria
| | - Benjamin Marty
- Institut de Myologie, CEA, Laboratoire de Résonance Magnétique Nucléaire, 75013 Paris, France
| | - Khaoula Bouazizi
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
- Sorbonne Université, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, 75006 Paris, France
| | - Nadjia Kachenoura
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
- Sorbonne Université, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, 75006 Paris, France
| | - Céline Piedvache
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité de Recherche Clinique, 94275 Le Kremlin-Bicêtre, France
| | - Anne Blanchard
- Université de Paris, Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Centre d'Investigations Cliniques, Inserm CIC1318 et UMR 1138, 75015 Paris, France
| | - Sylvie Salenave
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Mikaël Prigent
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
| | - Christel Jublanc
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Service d'Endocrinologie-Métabolisme, 75013 Paris, France
| | - Christiane Ajzenberg
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Médecine Interne, 94000 Créteil, France
| | - Céline Droumaguet
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Service de Médecine Interne, 94000 Créteil, France
| | - Jacques Young
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Emmanuelle Kuhn
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Helene Agostini
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité de Recherche Clinique, 94275 Le Kremlin-Bicêtre, France
| | - Severine Trabado
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, 94275 Le Kremlin-Bicêtre, France
| | - Pierre G Carlier
- Institut de Myologie, CEA, Laboratoire de Résonance Magnétique Nucléaire, 75013 Paris, France
| | - Bruno Fève
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service d'Endocrinologie et Métabolisme, Centre de Référence des Maladies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité (PRISIS), Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, UMR-S938, IHU ICAN, 75012 Paris, France
| | - Alban Redheuil
- Sorbonne Université, CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, 75006 Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique, APHP.SU, 75013 Paris, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Peter Kamenický
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
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Lee GW, Kang MH, Ro WB, Song DW, Park HM. Circulating Galectin-3 Evaluation in Dogs With Cardiac and Non-cardiac Diseases. Front Vet Sci 2021; 8:741210. [PMID: 34722704 PMCID: PMC8551921 DOI: 10.3389/fvets.2021.741210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/10/2021] [Indexed: 12/28/2022] Open
Abstract
Galectin-3 is involved in important biological functions such as fibrogenesis and inflammation. Notably, it is associated with various diseases and plays a major role in cardiac inflammation and fibrosis. Although heart diseases are relatively common in dogs, a few studies have analyzed the circulating galectin-3 concentration in dogs with various heart diseases, including myxomatous mitral valve disease, patent ductus arteriosus, and pulmonic stenosis. The aims of the present study were to evaluate the effect of heart disease on circulating galectin-3 levels in dogs, and also to evaluate the correlation between galectin-3 concentration and conventional echocardiographic indices along with N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration in dogs with heart diseases. The medical records and archived serum samples of 107 dogs were evaluated retrospectively. In total, 107 dogs were classified into healthy dogs (n = 8), cardiac disease (n = 26), and non-cardiac disease groups (n = 73). The circulatory galectin-3 levels were analyzed using a commercially available canine-specific galectin-3 enzyme-linked immunosorbent assay kit. This study demonstrated that dogs with heart, endocrine, and dermatologic diseases had significantly higher galectin-3 levels than healthy dogs (p = 0.009, p = 0.007, and p = 0.026, respectively). Among dogs with heart diseases, dogs with concentric cardiomyopathy had significantly increased circulatory galectin-3 levels compared with healthy dogs (p = 0.028). E′/A′ had a positive association with galectin-3 levels among conventional echocardiographic indices. Moreover, the galectin-3 concentration could predict diastolic dysfunction. In dogs with myxomatous mitral valve disease, a significantly positive correlation was revealed between galectin-3 levels and NT-proBNP levels (p = 0.007). Overall, this study demonstrates that circulatory galectin-3 levels increase in dogs with heart, endocrine, and dermatologic diseases. Moreover, this study demonstrates that galectin-3 concentration could be helpful to evaluate cardiac remodeling and diastolic function. Further large-scale research is required to evaluate the role of circulating galectin-3 in dogs with heart diseases.
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Affiliation(s)
- Ga-Won Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Min-Hee Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Woong-Bin Ro
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Doo-Won Song
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Hee-Myung Park
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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Gehlen H, Fisch J, Merle R, Trachsel DS. Preliminary study on the effects of pergolide on left ventricular function in the horses with pituitary pars intermedia dysfunction. J Vet Sci 2021; 22:e64. [PMID: 34553515 PMCID: PMC8460455 DOI: 10.4142/jvs.2021.22.e64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pituitary pars intermedia dysfunction (PPID), a neurodegenerative disease leading to reduced dopamine production, is a common disease in aged horses. The treatment is based on administration of the dopamine agonist pergolide. This drug has been related to valvular fibrosis in humans, but the cardiovascular effect of this drug has not yet been investigated in horses. OBJECTIVES To determine whether pergolide induces valvular disease in horses or affects the cardiac function. METHODS Standard, tissue Doppler (TDE) and two-dimensional speckle tracking (STE) echocardiography were performed in horses with diagnosed PPID based on adrenocorticotropic hormone dosage. Measurements taken in horses treated with pergolide were compared with those from untreated horses with nonparametric t-tests. Furthermore, measurements from follow-up examinations performed at least three months after the initial exam were compared with a Wilcoxon signed rank test for repeated measurements in each group. RESULTS Twenty-three horses were included. None of the 12 horses under treatment developed valvular regurgitation. Furthermore, no differences in the measurements of the left ventricular systolic or diastolic function could be seen between the group of horses with treatment and those without treatment. Measurements taken in the follow-up exam did not differ compared to those taken in the initial exam in both groups. CONCLUSIONS No changes of the left ventricular function assessed by TDE and STE could be shown in a small population of horses with confirmed PPID. Treatment with pergolide did not affect the ventricular function nor induce valvular disease.
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Affiliation(s)
- Heidrun Gehlen
- Department of Veterinary Medicine, Equine Clinic: Surgery and Radiology, Freie University Berlin, Berlin 14163, Germany
| | - Judith Fisch
- Department of Veterinary Medicine, Equine Clinic: Surgery and Radiology, Freie University Berlin, Berlin 14163, Germany
| | - Roswitha Merle
- Department of Veterinary Medicine, Institute for Veterinary Epidemiology and Biostatistics, Freie University Berlin, Berlin 14163, Germany
| | - Dagmar S Trachsel
- Department of Veterinary Medicine, Equine Clinic: Surgery and Radiology, Freie University Berlin, Berlin 14163, Germany.
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Role of Two-Dimensional Speckle-Tracking Echocardiography in Early Detection of Left Ventricular Dysfunction in Dogs. Animals (Basel) 2021; 11:ani11082361. [PMID: 34438818 PMCID: PMC8388726 DOI: 10.3390/ani11082361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Two-dimensional speckle-tracking echocardiography represents an advanced imaging technique that allows the analysis of global and regional myocardial function, cardiac rotation and synchronicity using deformation imaging. It has gained growing importance over the last decade, especially in human medicine as a method of evaluating myocardial function. This review aims to give an overview of the current understanding of this technique and its clinical applicability in the field of veterinary medicine with a focus on early detection of left ventricular dysfunction in dogs. Abstract Two-dimensional speckle-tracking echocardiography (2D–STE) is an advanced echocardiographic technique based on deformation imaging that allows comprehensive evaluation of the myocardial function. Clinical application of 2D–STE holds great potential for its ability to provide valuable information on both global and regional myocardial function and to quantify cardiac rotation and synchronicity, which are not readily possible with the conventional echocardiography. It has gained growing importance over the past decade, especially in human medicine, and its application includes assessment of myocardial function, detection of subclinical myocardial dysfunction and serving as a prognostic indicator. This review illustrates the fundamental concepts of deformation analysis and gives an overview of the current understanding and its clinical application of this technique in veterinary medicine, with a focus on early detection of left ventricular (LV) dysfunction in dogs.
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12
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Reincke M. Cushing Syndrome Associated Myopathy: It Is Time for a Change. Endocrinol Metab (Seoul) 2021; 36:564-571. [PMID: 34139801 PMCID: PMC8258338 DOI: 10.3803/enm.2021.1069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 12/27/2022] Open
Abstract
Cushing syndrome is the result of excessive levels of glucocorticoids. Endogenous Cushing syndrome is rare with an incidence of two to three cases per million per year. Clinically, the presentation consists of a characteristic phenotype including skin symptoms and metabolic manifestations. A frequent co-morbidity with high impact on quality of life is Cushing syndrome associated myopathy. It characteristically affects the proximal myopathy, impairing stair climbing and straightening up. The pathophysiology is complex and involves protein degradation via the forkhead box O3 (FOXO3) pathway, intramuscular fat accumulation, and inactivity-associated muscle atrophy. Surgical remission of Cushing syndrome is the most important step for recovery of muscle function. Restoration depends on age, co-morbidities and postoperative insulin-like growth factor concentrations. At average, functionality remains impaired during the long-term compared to age and sex matched control persons. Growth hormone therapy in individuals with impaired growth hormone secretion could be an option but has not been proved in a randomized trial.
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Affiliation(s)
- Martin Reincke
- Medical Department IV, LMU-University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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13
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Impact of cortisol on blood pressure and hypertension-mediated organ damage in hypertensive patients. J Hypertens 2021; 39:1412-1420. [PMID: 33534343 DOI: 10.1097/hjh.0000000000002801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients with overt and subclinical Cushing's syndrome frequently develop hypertension, metabolism disorders, and atherosclerotic lesions. The aim of the present study was to test the association between cortisol and blood pressure (BP), organ damage, and metabolic parameters in hypertensive patients without hypercortisolism. METHODS After exclusion of patients treated with corticosteroids or with Cushing's syndrome, the cohort included 623 hypertensive patients (mean ± SD age 50.3 ± 15.4 years, 50.9% men, median 24-h BP 146/88 mmHg) with an extended work-up (lipid profile, hypertension-mediated organ damage). Cortisol secretion was assessed by plasma cortisol at 0800 and 1600 h, and by 24-h urinary free cortisol (24 h UFC) normalized if required to urine creatinine (UFC/U creat). RESULTS Plasma cortisol at 1600 h, 24 h-UFC, and UFC/U creat were significantly and positively correlated with daytime, night-time, and 24-h SBP; plasma cortisol at 0800 h was not associated with BP. The strongest correlations were observed in the subgroup of aged more than 50 years (correlation coefficients between 0.23 and 0.28). These correlations remained after adjustment on plasma aldosterone. Metabolic parameters were weakly associated with cortisol. Arterial stiffness (central pulse pressure and pulse wave velocity), plasma NT-proBNP, and microalbuminuria were significantly correlated with 24 h UFC, UFC/U creat, and plasma cortisol at 1600 h. CONCLUSION Cortisol influences weakly the level of BP independently from plasma aldosterone in hypertensive patients, particularly in older patients, and that there was weak association with HMOD. It may, therefore, be of interest to test specific treatments targeting cortisol excess in selected hypertensive patients.
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Ehrlich K, Morbach C, Reiter T, Heuschmann PU, Hannemann A, Fassnacht M, Störk S, Hahner S, Deutschbein T. Rationale and design of the cardiovascular status in patients with endogenous cortisol excess study (CV-CORT-EX): a prospective non-interventional follow-up study. BMC Endocr Disord 2021; 21:11. [PMID: 33419423 PMCID: PMC7791745 DOI: 10.1186/s12902-020-00665-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/11/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Endogenous Cushing's syndrome (CS) results in increased cardiovascular (CV) morbidity and mortality. So far, most studies focussed on distinct disease entities rather than the integrity of the CV system. We here describe the design of the Cardiovascular Status in Endogenous Cortisol Excess Study (CV-CORT-EX), a study aiming to comprehensively investigate the health status of patients with endogenous CS (with a particular focus on CV phenotypes, biochemical aspects, quality of life, and psychosocial status). METHOD A prospective non-interventional cohort study performed at a German tertiary referral centre. At the time of enrolment, patients will be categorised as: (1) newly diagnosed overt CS, (2) recurrent overt CS, (3) CS in remission, (4) presence of mild autonomous cortisol excess (MACE). The target cohorts will be n = 40 (groups 1 + 2), n = 80 (group 3), and n = 20 (group 4). Patients with overt CS at the time of enrolment will be followed for 12 months after remission (with re-evaluations after 6 and 12 months). At each visit, patients will undergo transthoracic echocardiography, cardiac magnetic resonance imaging, 24-h electrocardiogram, 24-h blood pressure measurement, and indirect evaluation of endothelial function. Furthermore, a standardised clinical investigation, an extensive biochemical workup, and a detailed assessment of quality of life and psychosocial status will be applied. Study results (e.g. cardiac morphology and function according to transthoracic echocardiography and cardiac magnetic resonance imaging; e.g. prevalence of CV risk factors) from patients with CS will be compared with matched controls without CS derived from two German population-based studies. DISCUSSION CV-CORT-EX is designed to provide a comprehensive overview of the health status of patients with endogenous CS, mainly focussing on CV aspects, and the holistic changes following remission. TRAIL REGISTRATION ClinicalTrials.gov ( https://clinicaltrials.gov/ ) NCT03880513, registration date: 19 March 2019 (retrospectively registered). Protocol Date: 28 March 2014, Version 2.
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Affiliation(s)
- Kristina Ehrlich
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Caroline Morbach
- Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Academic Core Lab Ultrasound-based Cardiovascular Imaging, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Theresa Reiter
- Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Peter Ulrich Heuschmann
- Clinical Trial Centre, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
- Medicover Oldenburg MVZ, Oldenburg, Germany.
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Jurek A, Krzesiński P, Gielerak G, Witek P, Zieliński G, Kazimierczak A, Wierzbowski R, Banak M, Uziębło-Życzkowska B. Cushing's Disease: Assessment of Early Cardiovascular Hemodynamic Dysfunction With Impedance Cardiography. Front Endocrinol (Lausanne) 2021; 12:751743. [PMID: 34659130 PMCID: PMC8517395 DOI: 10.3389/fendo.2021.751743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cushing's disease is a rare condition associated with a high cardiovascular risk and hypercortisolemia-related hemodynamic dysfunction, the extent of which can be assessed with a noninvasive method, called impedance cardiography. The standard methods for hemodynamic assessment, such as echocardiography or ambulatory blood pressure monitoring may be insufficient to fully evaluate patients with Cushing's disease; therefore, impedance cardiography is being currently considered a new modality for assessing early hemodynamic dysfunction in this patient population. The use of impedance cardiography for diagnosis and treatment of Cushing's disease may serve as personalized noninvasive hemodynamic status assessment and provide a better insight into the pathophysiology of Cushing's disease. The purpose of this study was to assess the hemodynamic profile of Cushing's disease patients and compare it with that in the control group. MATERIAL AND METHODS This observational prospective clinical study aimed to compare 54 patients with Cushing's disease (mean age 41 years; with 64.8% of this population affected with arterial hypertension) and a matched 54-person control group (mean age 45 years; with 74.1% of this population affected with arterial hypertension). The hemodynamic parameters assessed with impedance cardiography included the stroke index (SI), cardiac index (CI), systemic vascular resistance index (SVRI), velocity index (VI), (ACI), Heather index (HI), and thoracic fluid content (TFC). RESULTS The Cushing's disease group was characterized by a higher diastolic blood pressure and a younger age than the control group (82.9 vs. 79.1 mmHg, p=0.045; and 41.1 vs. 44.9 years, p=0.035, respectively). Impedance cardiography parameters in the Cushing's disease group showed: lower values of SI (42.1 vs. 52.8 ml/m2; p ≤ 0.0001), CI (2.99 vs. 3.64 l/min/m2; p ≤ 0,0001), VI (42.9 vs. 52.1 1/1000/s; p=0.001), ACI (68.7 vs. 80.5 1/100/s2; p=0,037), HI (13.1 vs. 15.2 Ohm/s2; p=0.033), and TFC (25.5 vs. 27.7 1/kOhm; p=0.006) and a higher SVRI (2,515 vs. 1,893 dyn*s*cm-5*m2; p ≤ 0.0001) than those in the control group. CONCLUSIONS Cushing's disease is associated with significantly greater vasoconstriction and left ventricular systolic dysfunction. An individual assessment with impedance cardiography may be useful in Cushing's disease patients in order to identify subclinical cardiovascular complications of chronic hypercortisolemia as potential therapeutic targets.
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Affiliation(s)
- Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
- *Correspondence: Agnieszka Jurek,
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Zieliński
- Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland
| | - Anna Kazimierczak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Robert Wierzbowski
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Banak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
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Zhang QQ, Li GQ, Zhong Y, Wang J, Wang AN, Zhou X, Mao XM. Empagliflozin improves chronic hypercortisolism-induced abnormal myocardial structure and cardiac function in mice. Ther Adv Chronic Dis 2020; 11:2040622320974833. [PMID: 33294147 PMCID: PMC7705186 DOI: 10.1177/2040622320974833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/29/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Chronic exposure to excess glucocorticoids is frequently associated with a specific cardiomyopathy. Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has beneficial effects as it aids in the reduction of heart failure and cardiovascular mortality in hospitalized patients. The aim of this study was to investigate the effects of empagliflozin on chronic hypercortisolism-induced myocardial fibrosis and myocardial dysfunction in mice. Methods: Male C57BL/6J mice (6 weeks old) were randomized to control, corticosterone (CORT), and empagliflozin + CORT groups. After 4 weeks of administration, heart structure and function were evaluated by echocardiography, and peripheral blood and tissue samples were collected. Expressions of Ccl2, Itgax, Mrc1, and Adgre1 mRNA in heart tissue were evaluated by RT-PCR, and signal transducer and activator of transcription 3 (STAT3) and Toll-like receptor 4 (TLR4) protein expression were analyzed by Western blotting. Results: Empagliflozin effectively reduced body weight, liver triglyceride, visceral adipose volume, and uric acid in CORT-treated mice. Left ventricular hypertrophy and cardiac dysfunction were improved significantly, phosphorylated STAT3 and TLR4 were alleviated, and macrophage infiltration in the myocardium was inhibited after administration of empagliflozin in CORT-treated mice. Conclusion: Empagliflozin has beneficial effects on specific cardiomyopathy associated with CORT, and the results provide new evidence that empagliflozin might be a potential drug for the prevention of this disease.
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Affiliation(s)
- Qing-Qing Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guo-Qing Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yi Zhong
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - An-Ning Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao Zhou
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Ming Mao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68 ChangLe St., Nanjing, 210006, China
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17
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Packer M, Lam CS, Lund LH, Maurer MS, Borlaug BA. Characterization of the inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease. Eur J Heart Fail 2020; 22:1551-1567. [PMID: 32441863 PMCID: PMC7687188 DOI: 10.1002/ejhf.1902] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022] Open
Abstract
Accumulating evidence points to the existence of an inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction (HFpEF), which is characterized by biomarkers of inflammation, an expanded epicardial adipose tissue mass, microvascular endothelial dysfunction, normal-to-mildly increased left ventricular volumes and systolic blood pressures, and possibly, altered activity of adipocyte-associated inflammatory mediators. A broad range of adipogenic metabolic and systemic inflammatory disorders - e.g. obesity, diabetes and metabolic syndrome as well as rheumatoid arthritis and psoriasis - can cause this phenotype, independent of the presence of large vessel coronary artery disease. Interestingly, when compared with men, women are both at greater risk of and may suffer greater cardiac consequences from these systemic inflammatory and metabolic disorders. Women show disproportionate increases in left ventricular filling pressures following increases in central blood volume and have greater arterial stiffness than men. Additionally, they are particularly predisposed to epicardial and intramyocardial fat expansion and imbalances in adipocyte-associated proinflammatory mediators. The hormonal interrelationships seen in inflammatory-metabolic phenotype may explain why mineralocorticoid receptor antagonists and neprilysin inhibitors may be more effective in women than in men with HFpEF. Recognition of the inflammatory-metabolic phenotype may improve an understanding of the pathogenesis of HFpEF and enhance the ability to design clinical trials of interventions in this heterogeneous syndrome.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical CenterDallasTXUSA
- Imperial College LondonLondonUK
| | - Carolyn S.P. Lam
- National Heart Centre Singapore and Duke‐National University of SingaporeSingapore
- University Medical Centre GroningenGroningenThe Netherlands
- The George Institute for Global HealthSydneyAustralia
| | - Lars H. Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
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Di Dalmazi G, Vicennati V, Pizzi C, Mosconi C, Tucci L, Balacchi C, Cosentino ER, Paolisso P, Fanelli F, Gambineri A, Pelusi C, Repaci A, Garelli S, Galiè N, Borghi C, Golfieri R, Pagotto U. Prevalence and Incidence of Atrial Fibrillation in a Large Cohort of Adrenal Incidentalomas: A Long-Term Study. J Clin Endocrinol Metab 2020; 105:5837818. [PMID: 32413902 DOI: 10.1210/clinem/dgaa270] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/08/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Chronic glucocorticoids excess leads to morphological and functional cardiac alterations, a substrate for arrhythmias. Autonomous cortisol secretion (ACS) in adrenal incidentalomas is a model of chronic endogenous hypercortisolism. OBJECTIVE To investigate prevalence and incidence of atrial fibrillation (AF) in a large cohort of patients with ACS. DESIGN Retrospective study. SETTING University hospital. PATIENTS Patients evaluated between 1990 and 2018 for adrenal incidentalomas (n = 632), without pheochromocytoma, primary aldosteronism, Cushing syndrome, congenital adrenal hyperplasia, and adrenal malignancy. Cortisol after 1-mg dexamethasone suppression test < or > 50 nmol/L defined nonsecreting tumors (NST) (n = 420) and ACS (n = 212), respectively. INTERVENTION Assessment of AF at baseline (n = 632) and during a median follow-up of 7.7 years retrospectively (NST, n = 249; ACS, n = 108). Comparison with general population. MAIN OUTCOME MEASURE Prevalence and incidence of AF. RESULTS AF prevalence was higher in patients with ACS (8.5%) than NST (3.1%, P = 0.003) and the general population (1.7%; P < 0.001 vs ACS, P = 0.034 vs NST). The age-adjusted rate ratio to the general population was 1.0 for NST and 2.6 for ACS. AF was associated with ACS (odds ratio, 2.40; 95% confidence interval [CI], 1.07-5.39; P = 0.035). The proportion of patients with AF at last evaluation was higher in ACS (20.0%) than NST (11.9%; P = 0.026). ACS showed a higher risk of incident AF than NST (hazard ratio, 2.95; 95% CI, 1.27-6.86; P = 0.012), which was associated with post-dexamethasone cortisol (hazard ratio, 1.15; 95% CI, 1.07-1.24; P < 0.001), independently of known contributing factors. CONCLUSIONS Patients with adrenal incidentalomas and ACS are at risk of AF. Electrocardiogram monitoring may be recommended during follow-up.
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Affiliation(s)
- Guido Di Dalmazi
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Valentina Vicennati
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Carmine Pizzi
- Division of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristina Mosconi
- Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Preventive Medicine, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Lorenzo Tucci
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Caterina Balacchi
- Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Preventive Medicine, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Eugenio Roberto Cosentino
- Hypertension Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Pasquale Paolisso
- Division of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Flaminia Fanelli
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessandra Gambineri
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Carla Pelusi
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Repaci
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Silvia Garelli
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Nazzareno Galiè
- Division of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Borghi
- Hypertension Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Rita Golfieri
- Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Preventive Medicine, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Uberto Pagotto
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University Alma Mater Studiorum of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Pingle SR, Shah T, Mosleh W, Kim AS. Cushing syndrome cardiomyopathy: an unusual manifestation of small-cell lung cancer. ESC Heart Fail 2020; 7:3189-3192. [PMID: 32573943 PMCID: PMC7524218 DOI: 10.1002/ehf2.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 01/12/2023] Open
Abstract
Cushing syndrome is a rare cause of dilated cardiomyopathy and heart failure with reduced ejection fraction. Cases describing this association are scarce. We describe a patient presenting with acute heart failure, new cardiomyopathy, refractory hypokalaemia, severe hyperglycaemia, and uncontrolled hypertension who was found to have hypercortisolism secondary to an ectopic adrenocorticotropic hormone‐secreting primary lung neoplasm. This case highlights the effects of hypercortisolism on the myocardium. The finding of a non‐dilated cardiomyopathy in this case is unique because the majority of previously reported Cushing syndrome cardiomyopathy cases have described left ventricular dilatation or significant left ventricular hypertrophy. In addition, small‐cell lung cancer with adrenocorticotropic hormone production causing Cushing syndrome cardiomyopathy is rare.
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Affiliation(s)
- Srinath-Reddi Pingle
- Department of Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-2202, USA
| | - Tanvi Shah
- Department of Medicine, St. Vincent's Hospital, Worcester, MA, USA
| | - Wassim Mosleh
- Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-2202, USA
| | - Agnes S Kim
- Department of Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-2202, USA.,Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-2202, USA
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20
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Roerink SHPP, Cocks MS, Wagenmakers MAEM, Rodighiero RP, Strauss JA, Shepherd SO, Plantinga TS, Thijssen DHJ, Hopman MTE, Pereira AM, Smit JW, Wagenmakers AJM, Netea-Maier RT, Hermus ARMM. Decreased Aerobic Exercise Capacity After Long-Term Remission From Cushing Syndrome: Exploration of Mechanisms. J Clin Endocrinol Metab 2020; 105:5681573. [PMID: 31858120 PMCID: PMC7067548 DOI: 10.1210/clinem/dgz286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although major improvements are achieved after cure of Cushing syndrome (CS), fatigue and decreased quality of life persist. This is the first study to measure aerobic exercise capacity in patients in remission of CS for more than 4 years in comparison with matched controls, and to investigate whether the reduction in exercise capacity is related to alterations in muscle tissue. METHODS Seventeen patients were included. A control individual, matched for sex, estrogen status, age, body mass index, smoking, ethnicity, and physical activity level was recruited for each patient. Maximal aerobic capacity (VO2peak) was assessed during incremental bicycle exercise to exhaustion. In 8 individually matched patients and controls, a percutaneous muscle biopsy was obtained and measures were made of cross-sectional areas, capillarization, and oxphos complex IV (COXIV) protein content as an indicator of mitochondrial content. Furthermore, protein content of endothelial nitric oxide synthase (eNOS) and eNOS phosphorylated on serine1177 and of the NAD(P)H-oxidase subunits NOX2, p47phox, and p67phox were measured in the microvascular endothelial layer. FINDINGS Patients showed a lower mean VO2peak (SD) (28.0 [7.0] vs 34.8 [7.9] ml O2/kg bw/min, P < .01), maximal workload (SD) (176 [49] vs 212 [67] watt, P = .01), and oxygen pulse (SD) (12.0 [3.7] vs 14.8 [4.2] ml/beat, P < .01) at VO2peak. No differences were seen in muscle fiber type-specific cross-sectional area, capillarization measures, mitochondrial content, and protein content of eNOS, eNOS-P-ser1177, NOX2, p47phox, and p67phox. INTERPRETATION Because differences in muscle fiber and microvascular outcome measures are not statistically significant, we hypothesize that cardiac dysfunction, seen in active CS, persists during remission and limits blood supply to muscles.
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Affiliation(s)
- Sean H P P Roerink
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
- Correspondence: Sean H. P. P. Roerink, MD, Department of Endocrinology (471), PO Box 9101, 6500 HB Nijmegen, the Netherlands. E-mail:
| | - Matthew S Cocks
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Margreet A E M Wagenmakers
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
- Center for Lysosomal and Metabolic Diseases, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Raffaella P Rodighiero
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Juliette A Strauss
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sam O Shepherd
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Theo S Plantinga
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dick H J Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anton J M Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ad R M M Hermus
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
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21
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Tona F, Boscaro M, Barbot M, Maritan L, Famoso G, Dal Lin C, Montisci R, Fallo F, Iliceto S, Scaroni C. New insights to the potential mechanisms driving coronary flow reserve impairment in Cushing's syndrome: A pilot noninvasive study by transthoracic Doppler echocardiography. Microvasc Res 2020; 128:103940. [DOI: 10.1016/j.mvr.2019.103940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
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22
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Szychlińska M, Baranowska-Jurkun A, Matuszewski W, Wołos-Kłosowicz K, Bandurska-Stankiewicz E. Markers of Subclinical Cardiovascular Disease in Patients with Adrenal Incidentaloma. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E69. [PMID: 32050625 PMCID: PMC7074127 DOI: 10.3390/medicina56020069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 01/19/2023]
Abstract
Due to the growing availability of imaging examinations the percentage of patients with incidentally diagnosed adrenal tumors has increased. The vast majority of these lesions are benign, non-functioning adenomas, although according to various estimates even up to 30%-50% of patients with adrenal incidentaloma may present biochemical hypercortisolemia, without typical clinical features of Cushing's syndrome. Adrenal adenomas secreting small amounts of glucocorticoids may cause morphological and functional changes in the myocardium and blood vessels. Early stages of cardiovascular remodeling may be observed among asymptomatic patients with adrenal adenoma. Vascular changes precede the development of cardiovascular diseases and can increase morbidity and mortality in patients with adrenal incidentaloma. This risk may result not only from the traditional risk factors. Seemingly hormonally inactive adrenal tumors can indeed produce small amounts of glucocorticoids that have metabolic implications. Therefore, evaluation of patients with incidental adrenal findings presenting with subclinical cardiovascular disease seems of particular importance.
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Affiliation(s)
- Magdalena Szychlińska
- Clinic of Endocrinology, Diabetology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-900 Olsztyn, Poland; (A.B.-J.); (W.M.); (K.W.-K.); (E.B.-S.)
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23
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Sakota M, Tatebe S, Sugimura K, Aoki T, Yamamoto S, Sato H, Kikuchi N, Konno R, Terui Y, Satoh K, Tezuka Y, Morimoto R, Saito M, Kuniyoshi S, Shimokawa H. Successful Management of Acute Congestive Heart Failure by Emergent Caesarean Section Followed by Adrenalectomy in a Pregnant Woman with Cushing's Syndrome-induced Cardiomyopathy. Intern Med 2019; 58:2819-2824. [PMID: 31243234 PMCID: PMC6815909 DOI: 10.2169/internalmedicine.2427-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Congestive heart failure (CHF) is rare during pregnancy. We herein report a 35-year-old woman who developed CHF with severe left ventricular dysfunction at 35 weeks' gestation. She underwent emergency Caesarean section followed by intensive-care treatment for CHF. The diagnosis of Cushing's syndrome (CS) caused by adrenal adenoma was confirmed by endocrinological examinations and histology after adrenalectomy. She was discharged on heart failure medications and glucocorticoid replacement therapy. Both the symptoms and cardiac function had recovered after 12 months of follow-up. This case highlights the importance of considering CS-induced cardiomyopathy as a cause of CHF in pregnant women.
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Affiliation(s)
- Miku Sakota
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Tatsuo Aoki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Saori Yamamoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Haruka Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Nobuhiro Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Ryo Konno
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Yosuke Terui
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Kimio Satoh
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Yuta Tezuka
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Ryo Morimoto
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Japan
| | - Shimpei Kuniyoshi
- Department of Pathology, Tohoku University Graduate School of Medicine, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
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24
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Koracevic G, Stojkovic M, Lovic D, Pavlovic M, Kostic T, Kutlesic M, Micic S, Koracevic M, Djordjevic M. Should Cushing's Syndrome be Considered as a Disease with High Cardiovascular Risk in Relevant Guidelines? Curr Vasc Pharmacol 2018; 18:12-24. [PMID: 30289080 DOI: 10.2174/1570161116666181005122339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/29/2018] [Accepted: 09/29/2018] [Indexed: 12/27/2022]
Abstract
A considerable amount of data supports a 1.8-7.4-fold increased mortality associated with Cushing's syndrome (CS). This is attributed to a high occurrence of several cardiovascular disease (CVD) risk factors in CS [e.g. adiposity, arterial hypertension (AHT), dyslipidaemia and type 2 diabetes mellitus (T2DM)]. Therefore, practically all patients with CS have the metabolic syndrome (MetS), which represents a high CVD risk. Characteristically, despite a relatively young average age, numerous patients with CS display a 'high' or 'very high' CVD risk (i.e. risk of a major CVD event >20% in the following 10 years). Although T2DM is listed as a condition with a high CVD risk, CS is not, despite the fact that a considerable proportion of the CS population will develop T2DM or impaired glucose tolerance. CS is also regarded as a risk factor for aortic dissection in current guidelines. This review considers the evidence supporting listing CS among high CVD risk conditions.
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Affiliation(s)
- Goran Koracevic
- Department for Cardiovascular Diseases, Clinical Centre, Nis, Serbia.,Medical Faculty, University of Nis, Nis, Serbia
| | | | - Dragan Lovic
- Clinic for Internal Medicine Intermedica, Nis, Serbia
| | - Milan Pavlovic
- Department for Cardiovascular Diseases, Clinical Centre, Nis, Serbia.,Medical Faculty, University of Nis, Nis, Serbia
| | - Tomislav Kostic
- Department for Cardiovascular Diseases, Clinical Centre, Nis, Serbia.,Medical Faculty, University of Nis, Nis, Serbia
| | | | | | | | - Milan Djordjevic
- Health Centre Jagodina, Emergency Medical Service, Jagodina, Serbia
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25
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Osswald A, Deutschbein T, Berr CM, Plomer E, Mickisch A, Ritzel K, Schopohl J, Beuschlein F, Fassnacht M, Hahner S, Reincke M. Surviving ectopic Cushing's syndrome: quality of life, cardiovascular and metabolic outcomes in comparison to Cushing's disease during long-term follow-up. Eur J Endocrinol 2018; 179:109-116. [PMID: 29875286 DOI: 10.1530/eje-18-0212] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/30/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Aim of our study was to analyze long-term outcome of patients with the ectopic Cushing's syndrome (ECS) compared to patients with Cushing's disease (CD) regarding cardiovascular, metabolic, musculoskeletal and psychiatric comorbidities. DESIGN Cross-sectional study in patients with ECS and CD in two German academic tertiary care centers. METHODS Standardized clinical follow-up examination was performed including health-related quality of life (QoL) in 21 ECS patients in long-term remission (≥18 months since successful surgery). Fifty-nine patients with CD in remission served as controls. RESULTS Time from first symptoms to diagnosis of Cushing's syndrome (CS) was shorter in ECS than in CD (8.5 (IQR: 30.3) vs 25 (IQR: 39.0) months, P = 0.050). ECS patients had lower self-reported psychiatric morbidity compared to CD (19% vs 43%, P = 0.050) at follow-up. Moreover, female ECS patients reported favorable scores for QoL in the SF-36 questionnaire (mental health: 92 (IQR: 30) vs 64 (IQR: 32) in CD, P = 0.010) and a Cushing-specific QoL questionnaire (73 (IQR: 18) vs 59 (IQR: 36) in CD, P = 0.030). In a pooled analysis of ECS and CD patients, QoL correlated with time from first symptoms until diagnosis of CS, but not with urinary free cortisol levels or serum cortisol after dexamethasone at the time of diagnosis. Long-term outcomes regarding hypertension, metabolic parameters, bone mineral density and grip strength were comparable in ECS and CD. CONCLUSIONS Our data support the concept that time of exposure to glucocorticoid excess appears to be a better predictor than peak serum cortisol levels at the time of diagnosis regarding long-term psychiatric morbidity and QoL.
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Affiliation(s)
- Andrea Osswald
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Timo Deutschbein
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Christina M Berr
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Eva Plomer
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Anne Mickisch
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Katrin Ritzel
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Martin Fassnacht
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
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26
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Abstract
Cortisol excess in Cushing's syndrome is associated with metabolic, cardiovascular, and cognitive alterations, only partially reversible after resolution of hypercortisolism. Elevated cardiovascular risk may persist after eucortisolism has been achieved. Fractures and low bone mineral density are also described in Cushing's syndrome in remission. Hypercortisolism may induce irreversible structural and functional changes in the brain, leading to neuropsychiatric disorders in the active phase of the disease, which persist. Sustained deterioration of the cardiovascular system, bone remodeling, and cognitive function along with neuropsychological impairment are associated with high morbidity and poor quality of life before and after remission.
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Affiliation(s)
- Susan M Webb
- Department of Endocrinology, Hospital Sant Pau, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII, c/Sant Antoni Maria Claret 167, Barcelona 08025, Spain; Department of Medicine, Hospital Sant Pau, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII, c/Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - Elena Valassi
- Department of Endocrinology, Hospital Sant Pau, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII, c/Sant Antoni Maria Claret 167, Barcelona 08025, Spain; Department of Medicine, Hospital Sant Pau, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII, c/Sant Antoni Maria Claret 167, Barcelona 08025, Spain.
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27
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Sbardella E, Minnetti M, D'Aluisio D, Rizza L, Di Giorgio MR, Vinci F, Pofi R, Giannetta E, Venneri MA, Vestri A, Morelli S, Lenzi A, Isidori AM. Cardiovascular features of possible autonomous cortisol secretion in patients with adrenal incidentalomas. Eur J Endocrinol 2018; 178:501-511. [PMID: 29510982 DOI: 10.1530/eje-17-0986] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 03/06/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Low-grade incomplete post-dexamethasone cortisol suppression in patients with adrenal incidentalomas - recently defined as possible autonomous cortisol secretion (pACS) - has been associated with increased cardiovascular events and mortality. However, prospective studies documenting cardiac abnormalities in these patients are lacking. SUBJECTS AND METHODS Between July 2016 and September 2017, 71 consecutive patients with adrenal lesions were prospectively screened for hypercortisolism by dexamethasone suppression test (NCT 02611258). Complete anthropometric, metabolic and hormonal parameters were recorded along with full cardiac ultrasound assessment and noninvasive measurement of arterial stiffness. All patients underwent chemical-shift magnetic resonance imaging to characterize the lesions. Cardiovascular outcomes were recorded in blind. RESULTS According to post-dexamethasone suppression cortisol values (post-DST), 34 patients had pACS and 37 non-functioning adenomas (NFA). The two groups were similar in sex, BMI, age distribution, cardiovascular risk factors and comorbidities. Left ventricular mass index (LVMIBSA) was increased in pACS compared to NFA (P = 0.006) and mildly correlated to the post-DST cortisol level (rho = 0.347; P = 0.004). The post-DST cortisol levels explained up to 13.7% of LVMIBSA variance (P = 0.002). Compared to NFA, patients with pACS had a higher prevalence of diastolic dysfunction (35.1% vs 82.6%; P = 0.001) and worse arterial stiffness assessed by pulse wave velocity (P = 0.033). CONCLUSIONS In apparently asymptomatic patients, mild autonomous cortisol secretion can sustain early cardiac and vascular remodeling, independently of other risk factors. The morphological and functional cardiovascular changes observed in pACS underline the need for further studies to correctly define the long-term management of this relatively common condition.
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Affiliation(s)
- Emilia Sbardella
- Departments of Experimental MedicineSapienza University of Rome, Rome, Italy
| | - Marianna Minnetti
- Departments of Experimental MedicineSapienza University of Rome, Rome, Italy
| | - Denise D'Aluisio
- Departments of Internal MedicineSapienza University of Rome, Rome, Italy
| | - Laura Rizza
- Departments of Experimental MedicineSapienza University of Rome, Rome, Italy
| | | | - Fabio Vinci
- Departments of Internal MedicineSapienza University of Rome, Rome, Italy
| | - Riccardo Pofi
- Departments of Experimental MedicineSapienza University of Rome, Rome, Italy
| | - Elisa Giannetta
- Departments of Experimental MedicineSapienza University of Rome, Rome, Italy
| | - Mary Anna Venneri
- Departments of Experimental MedicineSapienza University of Rome, Rome, Italy
| | - Annarita Vestri
- Public Health and Infectious DiseasesSapienza University of Rome, Rome, Italy
| | - Sergio Morelli
- Departments of Internal MedicineSapienza University of Rome, Rome, Italy
| | - Andrea Lenzi
- Departments of Experimental MedicineSapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Departments of Experimental MedicineSapienza University of Rome, Rome, Italy
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28
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Masters AK, Berger DJ, Ware WA, Langenfeld NR, Coetzee JF, Mochel JP, Ward JL. Effects of short-term anti-inflammatory glucocorticoid treatment on clinicopathologic, echocardiographic, and hemodynamic variables in systemically healthy dogs. Am J Vet Res 2018; 79:411-423. [DOI: 10.2460/ajvr.79.4.411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Rochette C, Castinetti F, Brue T. [Acromegaly and Cushing's disease: Persistence of comorbidities after the control of hypersecretion]. ANNALES D'ENDOCRINOLOGIE 2017. [PMID: 28645354 DOI: 10.1016/s0003-4266(17)30074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acromegaly and Cushing's disease lead to common and distinct comorbidities. Currently available treatments lead to the control of hyper secretion in the majority of cases. However, the prevalence of the comorbidities does not always go back to the one of the normal population after remission. For instance, about 1/3 of acromegalic patients with diabetes and half of patients with Cushing's disease and diabetes will have normal blood glucose values after remission. In contrast, high blood pressure frequently recovers after remission in both diseases. In contrast, while patients with acromegaly improve their lipid profile, patients with Cushing's disease frequently remain hypertriglyceridemic. Many other comorbidities (cardiovascular disease, bone alterations, altered quality of life) may persist after the control of hyper secretion. The aim of this review is to focus on the outcome of patients with acromegaly and Cuhing's disease, and to suggest the optimal follow-up of such patients in a multidisciplinary approach. These points have been discussed during the 2016 European Congress of Endocrinology, notably by J.Romijn and E.Valassi.
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Affiliation(s)
- C Rochette
- Université d'Aix-Marseille, Jardin du Pharo, 58 Boulevard Charles Livon, 13284 Marseille, France; Service d'endocrinologie-diabète-maladies métaboliques, Pôle ENDO, Centre de Référence Pathologies hypophysaires Rares, Hôpital de la Conception, 147 Boulevard Baille, 13005 Marseille, France
| | - F Castinetti
- Université d'Aix-Marseille, Jardin du Pharo, 58 Boulevard Charles Livon, 13284 Marseille, France; Service d'endocrinologie-diabète-maladies métaboliques, Pôle ENDO, Centre de Référence Pathologies hypophysaires Rares, Hôpital de la Conception, 147 Boulevard Baille, 13005 Marseille, France; Faculté de Médecine Secteur Nord, CNRS UMR 7286 - CRN2M, Boulevard Pierre Dramard, 13015 Marseille, France
| | - T Brue
- Université d'Aix-Marseille, Jardin du Pharo, 58 Boulevard Charles Livon, 13284 Marseille, France; Service d'endocrinologie-diabète-maladies métaboliques, Pôle ENDO, Centre de Référence Pathologies hypophysaires Rares, Hôpital de la Conception, 147 Boulevard Baille, 13005 Marseille, France; Faculté de Médecine Secteur Nord, CNRS UMR 7286 - CRN2M, Boulevard Pierre Dramard, 13015 Marseille, France.
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30
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Vassiliadi DA, Tsagarakis S. Cardiac hypertrophy in Cushing's syndrome: if not hypertension then what? Endocrine 2017; 56:453-455. [PMID: 28210938 DOI: 10.1007/s12020-017-1260-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/04/2017] [Indexed: 12/20/2022]
Affiliation(s)
- D A Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 106 76, Athens, Greece
| | - S Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 106 76, Athens, Greece.
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31
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Avenatti E, Rebellato A, Iannaccone A, Battocchio M, Dassie F, Veglio F, Milan A, Fallo F. Left ventricular geometry and 24-h blood pressure profile in Cushing's syndrome. Endocrine 2017; 55:547-554. [PMID: 27179657 DOI: 10.1007/s12020-016-0986-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/06/2016] [Indexed: 12/17/2022]
Abstract
Cushing's syndrome (CS) is associated with cardiovascular disease. The impact of the hemodynamic load on left ventricular mass (LVM) in patients with CS is not well known. In fact, the effects of 24-h blood pressure (BP) load and BP circadian rhythm on cardiac structure and function have not been studied. Aim of the present study has thus been to assess the presence of cardiac remodeling in patients with newly diagnosed CS, combining evaluation of cardiac remodeling and assessment of BP burden derived by 24-h ambulatory blood pressure monitoring (ABPM). 25 patients (4 M, 21 F) with CS underwent echocardiography in order to assess cardiac morphology and geometry (relative wall thickness-RWT). As controls, 25 subjects similar for demographic characteristics and 24-h BP were used. CS Patients were similar to controls by age, sex, mean 24-h BP, and body mass index. There was a significant increase in left ventricular mass (LVM; 44.4 ± 14.7 vs. 36.9 ± 10 g/m2.7, p = 0.03) and a significant increase in RWT (0.46 ± 0.07 vs. 0.41 ± 0.08, p = 0.02) in CS patients compared to controls. The prevalence of CS patients with pressure non-dipping profile was greater than that of controls (56 vs. 16 %, p < 0.05), with no significant association with LVM or geometry. 24-h urinary cortisol was not associated with LVM (r = 0.1, p = 0.5) or RWT (r = 0.02, p = 0.89) in the CS group. In conclusion, LVM and the concentric pattern of the left ventricle are relatively independent from 24-h BP load and profile (dipping/non-dipping) in CS patients.
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Affiliation(s)
- Eleonora Avenatti
- Internal Medicine and Hypertension Division, Department of Medical Sciences, University Hospital AOU Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Andrea Rebellato
- Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Andrea Iannaccone
- Internal Medicine and Hypertension Division, Department of Medical Sciences, University Hospital AOU Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126, Turin, Italy
| | | | - Francesca Dassie
- Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Franco Veglio
- Internal Medicine and Hypertension Division, Department of Medical Sciences, University Hospital AOU Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Alberto Milan
- Internal Medicine and Hypertension Division, Department of Medical Sciences, University Hospital AOU Città della Salute e della Scienza di Torino, University of Torino, Via Genova 3, 10126, Turin, Italy.
| | - Francesco Fallo
- Department of Medicine-DIMED, University of Padova, Padua, Italy
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Uziębło-Życzkowska B, Krzesinński P, Witek P, Zielinński G, Jurek A, Gielerak G, Skrobowski A. Cushing's Disease: Subclinical Left Ventricular Systolic and Diastolic Dysfunction Revealed by Speckle Tracking Echocardiography and Tissue Doppler Imaging. Front Endocrinol (Lausanne) 2017; 8:222. [PMID: 28928716 PMCID: PMC5591890 DOI: 10.3389/fendo.2017.00222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 08/16/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Novel echocardiographic techniques, such as speckle tracking echocardiography (STE) and tissue Doppler imaging, are sensitive tools for assessing left ventricular (LV) performance. LV global longitudinal strain (GLS), assessed by STE, is a sensitive marker of myocardial systolic function. Cardiovascular complications in patients with Cushing's disease (CD) determine a higher mortality than that in an age- and gender-matched population. Cardiac systolic dysfunction may be detected in early stages by STE. Thus, the aim of this study was to investigate the usefulness of STE in detecting subclinical LV dysfunction in three groups of patients: CD group, arterial hypertension group (AHG), and healthy volunteers (HV). METHODS Echocardiographic assessments of LV systolic and diastolic function were performed in 171 subjects (CD: 22, AHG: 114, HV: 35) with no symptoms of heart failure. A statistical comparison included separate analyses for men and women. RESULTS CD patients showed good blood pressure (BP) control (below 140/90 mmHg in 82% of cases). However, in comparison AHG and HV groups they exhibited: (1) significantly lower LV contractility expressed by GLS (CD group: -17.7%, AHG group: -19.2%, HV: -20.0%; p = 0.004) and (2) higher prevalence of LV diastolic dysfunction (45.0, 14.2, 0.0%, respectively; p < 0.00001). Men with CD showed significantly more pronounced LV diastolic dysfunction. Cortisol excess in women was related to impaired LV systolic function. CONCLUSION CD, even with well-controlled BP, is associated with LV dysfunction which depends individually on sex. These hemodynamic alterations can be detected by modern non-invasive diagnostic tools and may become potential therapeutic objectives.
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Affiliation(s)
- Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
- *Correspondence: Beata Uziębło-Życzkowska,
| | - Paweł Krzesinński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Przemysław Witek
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | | | - Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Andrzej Skrobowski
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
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Frustaci A, Letizia C, Verardo R, Grande C, Petramala L, Russo MA, Chimenti C. Cushing Syndrome Cardiomyopathy: Clinicopathologic Impact of Cortisol Normalization. Circ Cardiovasc Imaging 2016; 9:e004569. [PMID: 26994116 DOI: 10.1161/circimaging.116.004569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Frustaci
- From Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences (A.F., C.C.) and Department of Internal Medicine, Center for Secondary Hypertension (C.L., L.P.), La Sapienza University, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy (A.F., R.V., C.G., C.C., M.A.R.).
| | - Claudio Letizia
- From Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences (A.F., C.C.) and Department of Internal Medicine, Center for Secondary Hypertension (C.L., L.P.), La Sapienza University, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy (A.F., R.V., C.G., C.C., M.A.R.)
| | - Romina Verardo
- From Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences (A.F., C.C.) and Department of Internal Medicine, Center for Secondary Hypertension (C.L., L.P.), La Sapienza University, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy (A.F., R.V., C.G., C.C., M.A.R.)
| | - Claudia Grande
- From Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences (A.F., C.C.) and Department of Internal Medicine, Center for Secondary Hypertension (C.L., L.P.), La Sapienza University, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy (A.F., R.V., C.G., C.C., M.A.R.)
| | - Luigi Petramala
- From Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences (A.F., C.C.) and Department of Internal Medicine, Center for Secondary Hypertension (C.L., L.P.), La Sapienza University, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy (A.F., R.V., C.G., C.C., M.A.R.)
| | - Matteo Antonio Russo
- From Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences (A.F., C.C.) and Department of Internal Medicine, Center for Secondary Hypertension (C.L., L.P.), La Sapienza University, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy (A.F., R.V., C.G., C.C., M.A.R.)
| | - Cristina Chimenti
- From Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences (A.F., C.C.) and Department of Internal Medicine, Center for Secondary Hypertension (C.L., L.P.), La Sapienza University, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy (A.F., R.V., C.G., C.C., M.A.R.)
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Roux C, Kachenoura N, Raissuni Z, Mousseaux E, Young J, Graves MJ, Jublanc C, Cluzel P, Chanson P, Kamenický P, Redheuil A. Effects of cortisol on the heart: characterization of myocardial involvement in cushing's disease by longitudinal cardiac MRI T1 mapping. J Magn Reson Imaging 2016; 45:147-156. [PMID: 27393826 DOI: 10.1002/jmri.25374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/21/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Cushing's disease (CD) is associated with alterations in cardiac geometry and function, shown to be reversible after treatment. Our aim was to study cortisol-related changes in myocardial content in CD at baseline and after treatment using MR myocardial T1 times. MATERIALS AND METHODS This is a longitudinal study performed in 10 patients with active CD matched with 10 hypertensive and 10 healthy controls. All subjects had MR after CD diagnosis and 6 months after cortisol normalization. The 1.5 Tesla MR protocol included left ventricular geometry and function assessment and MOLLI sequences before and after contrast injection as well as late gadolinium enhancement. RESULTS At baseline, native myocardial T1 was significantly higher in CD patients compared with controls and the hypertensive group (1056 ± 139 ms versus 929 ± 80 ms, P = 0.023; 1056 ± 139 ms versus 952 ± 51, P = 0.049). After treatment, native and postcontrast myocardial T1 decreased in CD patients versus controls (1056 ± 139 ms versus 832 ± 78, P = 0.006 and 483 ± 69 ms versus 395 ± 39 ms, P = 0.010) reaching values even lower than found in controls (P = 0.038 and P = 0.001, respectively). CONCLUSION Native myocardial T1 is increased in Cushing's disease independently from hypertension and notably decreases after effective treatment, highlighting its potential to detect subclinical diffuse myocardial involvement in this condition. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:147-156.
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Affiliation(s)
- Charles Roux
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France
| | - Nadjia Kachenoura
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Paris, France
| | | | - Elie Mousseaux
- Université Paris Descartes, INSERM UMR 970, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Européen George Pompidou, Service de Radiologie Cardiovasculaire, Paris, France
| | - Jacques Young
- Institut National de la Santé et de la Recherche Médicale (INSERM) U693, F-94276, Le Kremlin Bicêtre, France.,Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94276, Le Kremlin Bicêtre, France.,Université Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S 693, F-94276, Le Kremlin Bicêtre, France
| | - Martin J Graves
- Radiology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Christel Jublanc
- Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, service d'endocrinologie, IE3M, Paris, France
| | - Philippe Cluzel
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département d'Imagerie Cardiovasculaire, Paris, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94276, Le Kremlin Bicêtre, France.,Université Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S 693, F-94276, Le Kremlin Bicêtre, France.,Radiology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Peter Kamenický
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94276, Le Kremlin Bicêtre, France.,Université Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S 693, F-94276, Le Kremlin Bicêtre, France.,Radiology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Alban Redheuil
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département d'Imagerie Cardiovasculaire, Paris, France
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Pivonello R, Isidori AM, De Martino MC, Newell-Price J, Biller BMK, Colao A. Complications of Cushing's syndrome: state of the art. Lancet Diabetes Endocrinol 2016; 4:611-29. [PMID: 27177728 DOI: 10.1016/s2213-8587(16)00086-3] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/06/2015] [Accepted: 03/01/2016] [Indexed: 01/13/2023]
Abstract
Cushing's syndrome is a serious endocrine disease caused by chronic, autonomous, and excessive secretion of cortisol. The syndrome is associated with increased mortality and impaired quality of life because of the occurrence of comorbidities. These clinical complications include metabolic syndrome, consisting of systemic arterial hypertension, visceral obesity, impairment of glucose metabolism, and dyslipidaemia; musculoskeletal disorders, such as myopathy, osteoporosis, and skeletal fractures; neuropsychiatric disorders, such as impairment of cognitive function, depression, or mania; impairment of reproductive and sexual function; and dermatological manifestations, mainly represented by acne, hirsutism, and alopecia. Hypertension in patients with Cushing's syndrome has a multifactorial pathogenesis and contributes to the increased risk for myocardial infarction, cardiac failure, or stroke, which are the most common causes of death; risks of these outcomes are exacerbated by a prothrombotic diathesis and hypokalaemia. Neuropsychiatric disorders can be responsible for suicide. Immune disorders are common; immunosuppression during active disease causes susceptibility to infections, possibly complicated by sepsis, an important cause of death, whereas immune rebound after disease remission can exacerbate underlying autoimmune diseases. Prompt treatment of cortisol excess and specific treatments of comorbidities are crucial to prevent serious clinical complications and reduce the mortality associated with Cushing's syndrome.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Cristina De Martino
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - John Newell-Price
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK; The Endocrine Unit, The Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Beverly M K Biller
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
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Frustaci A, Letizia C, Verardo R, Grande C, Calvieri C, Russo MA, Chimenti C. Atrogin-1 Pathway Activation in Cushing Syndrome Cardiomyopathy. J Am Coll Cardiol 2016; 67:116-7. [PMID: 26764074 DOI: 10.1016/j.jacc.2015.10.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/22/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
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The hypertension of Cushing's syndrome: controversies in the pathophysiology and focus on cardiovascular complications. J Hypertens 2016; 33:44-60. [PMID: 25415766 PMCID: PMC4342316 DOI: 10.1097/hjh.0000000000000415] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cushing's syndrome is associated with increased mortality, mainly due to cardiovascular complications, which are sustained by the common development of systemic arterial hypertension and metabolic syndrome, which partially persist after the disease remission. Cardiovascular diseases and hypertension associated with endogenous hypercortisolism reveal underexplored peculiarities. The use of exogenous corticosteroids also impacts on hypertension and cardiovascular system, especially after prolonged treatment. The mechanisms involved in the development of hypertension differ, whether glucocorticoid excess is acute or chronic, and the source endogenous or exogenous, introducing inconsistencies among published studies. The pleiotropic effects of glucocorticoids and the overlap of the several regulatory mechanisms controlling blood pressure suggest that a rigorous comparison of in-vivo and in-vitro studies is necessary to draw reliable conclusions. This review, developed during the first ‘Altogether to Beat Cushing's syndrome’ workshop held in Capri in 2012, evaluates the most important peculiarities of hypertension associated with CS, with a particular focus on its pathophysiology. A critical appraisal of most significant animal and human studies is compared with a systematic review of the few available clinical trials. A special attention is dedicated to the description of the clinical features and cardiovascular damage secondary to glucocorticoid excess. On the basis of the consensus reached during the workshop, a pathophysiology-oriented therapeutic algorithm has been developed and it could serve as a first attempt to rationalize the treatment of hypertension in Cushing's syndrome.
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Cushing's Disease Presented by Reversible Dilated Cardiomyopathy. Case Rep Cardiol 2015; 2015:980897. [PMID: 26649206 PMCID: PMC4663299 DOI: 10.1155/2015/980897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Dilated cardiomyopathy is rarely reported among CS patients especially without hypertension and left ventricular hypertrophy. Materials and Methods. We hereby report a Cushing's syndrome case presenting with dilated cardiomyopathy. Results. A 48-year-old female patient was admitted to our clinic with severe proximal myopathy and dilated cardiomyopathy without ventricular hypertrophy. Cushing's disease was diagnosed and magnetic-resonance imaging of the pituitary gland revealed a microadenoma. Under diuretic and ketoconazole treatments, she underwent a successful transnasal/transsphenoidal adenomectomy procedure. Full recovery of symptoms and echocardiographic features was achieved after six months of surgery. Conclusion. Cushing's syndrome must be kept in mind as a reversible cause of dilated cardiomyopathy. Recovery of cardiomyopathy is achieved with successful surgery.
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Marchand L, Segrestin B, Lapoirie M, Favrel V, Dementhon J, Jouanneau E, Raverot G. Dilated Cardiomyopathy Revealing Cushing Disease: A Case Report and Literature Review. Medicine (Baltimore) 2015; 94:e2011. [PMID: 26579807 PMCID: PMC4652816 DOI: 10.1097/md.0000000000002011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Cardiovascular impairments are frequent in Cushing's syndrome and the hypercortisolism can result in cardiac structural and functional changes that lead in rare cases to dilated cardiomyopathy (DCM). Such cardiac impairment may be reversible in response to a eucortisolaemic state.A 43-year-old man with a medical past of hypertension and history of smoking presented to the emergency department with global heart failure. Coronary angiography showed a significant stenosis of a marginal branch and cardiac MRI revealed a nonischemic DCM. The left ventricular ejection fraction (LVEF) was estimated as 28% to 30%. Clinicobiological features and pituitary imaging pointed toward Cushing's disease and administration of adrenolytic drugs (metyrapone and ketoconazole) was initiated. Despite the normalization of cortisol which had been achieved 2 months later, the patient presented an acute heart failure. A massive mitral regurgitation secondary to posterior papillary muscle rupture was diagnosed as a complication of the occlusion of the marginal branch. After 6 months of optimal pharmacological treatment for systolic heart failure, as well as treatment with inhibitors of steroidogenesis, there was no improvement of LVEF. The percutaneous mitral valve was therefore repaired and a defibrillator implanted. The severity of heart failure contraindicated pituitary surgery and the patient was instead treated by stereotaxic radiotherapy.This is the first case reporting a Cushing's syndrome DCM without improvement of LVEF despite normalization of serum cortisol levels.
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Affiliation(s)
- Lucien Marchand
- From the Department of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France (LM, BS, ML, GR); Department of Radiotherapy, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France (VF); Department of Cardiology, Tonkin clinic, Villeurbanne, France (JD); Department of Neurosurgery, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France (EJ); and INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team, Lyon, France (EJ, GR)
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Ferraù F, Korbonits M. Metabolic comorbidities in Cushing's syndrome. Eur J Endocrinol 2015; 173:M133-57. [PMID: 26060052 DOI: 10.1530/eje-15-0354] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/09/2015] [Indexed: 12/12/2022]
Abstract
Cushing's syndrome (CS) patients have increased mortality primarily due to cardiovascular events induced by glucocorticoid (GC) excess-related severe metabolic changes. Glucose metabolism abnormalities are common in CS due to increased gluconeogenesis, disruption of insulin signalling with reduced glucose uptake and disposal of glucose and altered insulin secretion, consequent to the combination of GCs effects on liver, muscle, adipose tissue and pancreas. Dyslipidaemia is a frequent feature in CS as a result of GC-induced increased lipolysis, lipid mobilisation, liponeogenesis and adipogenesis. Protein metabolism is severely affected by GC excess via complex direct and indirect stimulation of protein breakdown and inhibition of protein synthesis, which can lead to muscle loss. CS patients show changes in body composition, with fat redistribution resulting in accumulation of central adipose tissue. Metabolic changes, altered adipokine release, GC-induced heart and vasculature abnormalities, hypertension and atherosclerosis contribute to the increased cardiovascular morbidity and mortality. In paediatric CS patients, the interplay between GC and the GH/IGF1 axis affects growth and body composition, while in adults it further contributes to the metabolic derangement. GC excess has a myriad of deleterious effects and here we attempt to summarise the metabolic comorbidities related to CS and their management in the perspective of reducing the cardiovascular risk and mortality overall.
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Affiliation(s)
- Francesco Ferraù
- Centre for Endocrinology William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Márta Korbonits
- Centre for Endocrinology William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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Takano H, Kokubu A, Sugimoto K, Sunahara H, Aoki T, Fujii Y. Left ventricular structural and functional abnormalities in dogs with hyperadrenocorticism. J Vet Cardiol 2015; 17:173-81. [DOI: 10.1016/j.jvc.2015.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/28/2015] [Accepted: 07/07/2015] [Indexed: 01/10/2023]
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Abstract
INTRODUCTION Cushing's syndrome is associated with a number of clinical manifestations and co-morbidities which may not resolve even after long-term remission leading to excessive mortality. MATERIALS AND METHODS This review summarizes the main manifestations of Cushing's syndrome (active or in remission) with particular focus on data from recently published literature. CONCLUSION Obesity and metabolic alterations, hypertension and cardio/cerebrovascular complications, hypercoagulability/thromboembolism, neuropsychiatric, muscle/skeletal and immune consequences remain the most challenging. Cardiovascular consequences and immunosuppression determine the main causes of death in Cushing's syndrome necessitating early intervention when possible.
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Affiliation(s)
- Georgia Ntali
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Old Rd, Headington, Oxford, OX3 7LJ, UK
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Abstract
Obesity is prevalent worldwide and associated with co-morbidities that result in increased cardiovascular risk. Hypertension is the most prevalent obesity comorbidity associated with increased cardiovascular risk. Obesity hypertension is a distinct subtype of essential hypertension. While endogenous Cushing's syndrome is an uncommon cause of both obesity and hypertension, the recent recognition of other hypercortisolemic states has raised the profile of hypercortisolism as an important contributor in obesity hypertension. The high prevalence of exogenous, iatrogenic, pseudo, and subclinical Cushing's syndromes makes hypercortisolism an important diagnostic consideration in the evaluation and management of patients with obesity hypertension who are resistant to conventional management. Available data suggest that the renin-angiotensin-aldosterone system modulating antihypertensives have the best efficacy in hypercortisolism-mediated obesity hypertension. Strategies aimed at reducing cortisol production and action also have utility. This review provides a comprehensive overview of the epidemiology, etiopathogenesis and management options available for glucocorticoid-mediated obesity hypertension.
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Chen HY, Lien YH, Huang HP. Assessment of left ventricular function by two-dimensional speckle-tracking echocardiography in small breed dogs with hyperadrenocorticism. Acta Vet Scand 2014; 56:88. [PMID: 25551792 PMCID: PMC4300024 DOI: 10.1186/s13028-014-0088-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 12/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyperadrenocorticism (HAC) is associated with an increased prevalence of hypertension. This study investigated the left ventricular function using two-dimensional speckle-tracking echocardiography (2D-STE) in small breed dogs affected with spontaneous HAC. Age-matched healthy controls (n = 9), dogs with pituitary-dependent hyperadrenocorticism (PDH, n = 10), and dogs with adrenal-dependent hyperadrenocorticism (ADH, n = 9) were included in this study. Conventional echocardiography, global longitudinal and circumferential strain, and strain rate were assessed. RESULTS On group-wise comparison, left ventricular free wall (LVFWd) and interventricular septal thickness in diastole (IVSd) were thickest in the ADH group, followed by the PDH and controls (P = 0.014 and P = 0.001, respectively). Neither LVFWd nor IVSd was correlated with systemic blood pressure (P = 0.238 and P = 0.113, respectively). The values of all variables derived from the global strain and strain rate in longitudinal and circumferential directions followed the same pattern: highest in the controls, followed by PDH and then ADH (all P < 0.05, respectively). On multiple regression analyses, global longitudinal strain, global longitudinal strain rate in systole and early diastole, and global circumferential strain all decreased linearly with increased IVSd (all P < 0.05). CONCLUSIONS Left ventricular hypertrophy (LVH) was more prevalent in the HAC group compared to the control group. Association between hypertension and development of LVH was not identified. Decreased global longitudinal and circumferential strains were associated with increased IVSd. 2D-STE revealed significant decreases in systolic functions that were undetected using conventional echocardiography in the ADH and PDH groups.
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Kamenický P, Redheuil A, Roux C, Salenave S, Kachenoura N, Raissouni Z, Macron L, Guignat L, Jublanc C, Azarine A, Brailly S, Young J, Mousseaux E, Chanson P. Cardiac structure and function in Cushing's syndrome: a cardiac magnetic resonance imaging study. J Clin Endocrinol Metab 2014; 99:E2144-53. [PMID: 25093618 PMCID: PMC4223435 DOI: 10.1210/jc.2014-1783] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with Cushing's syndrome have left ventricular (LV) hypertrophy and dysfunction on echocardiography, but echo-based measurements may have limited accuracy in obese patients. No data are available on right ventricular (RV) and left atrial (LA) size and function in these patients. OBJECTIVES The objective of the study was to evaluate LV, RV, and LA structure and function in patients with Cushing's syndrome by means of cardiac magnetic resonance, currently the reference modality in assessment of cardiac geometry and function. METHODS Eighteen patients with active Cushing's syndrome and 18 volunteers matched for age, sex, and body mass index were studied by cardiac magnetic resonance. The imaging was repeated in the patients 6 months (range 2-12 mo) after the treatment of hypercortisolism. RESULTS Compared with controls, patients with Cushing's syndrome had lower LV, RV, and LA ejection fractions (P < .001 for all) and increased end-diastolic LV segmental thickness (P < .001). Treatment of hypercortisolism was associated with an improvement in ventricular and atrial systolic performance, as reflected by a 15% increase in the LV ejection fraction (P = .029), a 45% increase in the LA ejection fraction (P < .001), and an 11% increase in the RV ejection fraction (P = NS). After treatment, the LV mass index and end-diastolic LV mass to volume ratio decreased by 17% (P < .001) and 10% (P = .002), respectively. None of the patients had late gadolinium myocardial enhancement. CONCLUSION Cushing's syndrome is associated with subclinical biventricular and LA systolic dysfunctions that are reversible after treatment. Despite skeletal muscle atrophy, Cushing's syndrome patients have an increased LV mass, reversible upon correction of hypercortisolism.
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Iwasaki H. Reversible alterations in cardiac morphology and functions in a patient with Cushing's syndrome. Endocrinol Diabetes Metab Case Rep 2014; 2014:140038. [PMID: 25031836 PMCID: PMC4075027 DOI: 10.1530/edm-14-0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 06/11/2014] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED A 45-year-old female was referred for endocrine evaluation of an incidental mass (31×24 mm in diameter) on the right adrenal gland. The patient was normotensive and nondiabetic, and had no history of generalised obesity (body weight, 46 kg at 20 years of age and 51.2 kg on admission); however, her waist-to-hip ratio was 0.97. Elevated urinary free cortisol levels (112-118 μg/day) and other findings indicated adrenocorticotrophic hormone-independent Cushing's syndrome due to right adrenocortical adenoma. Echocardiography before adrenalectomy revealed concentric left ventricular (LV) hypertrophy with a particular increase in interventricular septum thickness leading to impaired systolic and diastolic functions. Upon surgical remission of hypercortisolism, the asymmetric hypertrophy disappeared and the cardiac dysfunctions were considerably ameliorated. Although the mechanism(s) by which excessive cortisol contributes to LV wall thickness remain(s) unclear, serial echocardiography and cardiac multidetector-row computed tomography may support the notion that abnormal fat deposition in the myocardium owing to hypercortisolism appears to be an important factor for the reversible change in the cardiac morphology. LEARNING POINTS Patients with Cushing's syndrome occasionally exhibit severe LV hypertrophy related to systolic and diastolic dysfunctions although they have neither hypertension nor diabetes mellitus.Biological remission of hypercortisolism can normalise structural and functional cardiac parameters and help in differentiating the cardiac alterations induced by excessive cortisol from those induced by other diseases.Excessive lipid accumulation within the heart before myocardial fibrosis may be implicated in reversible alterations in the cardiac morphology by Cushing's syndrome.Early diagnosis and treatment of Cushing's syndrome appear to be pivotal in preventing irreversible cardiac dysfunctions subsequent to cardiovascular events and heart failure.
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Affiliation(s)
- Hiroaki Iwasaki
- Division of Endocrinology and Metabolism, Department of Internal Medicine Toshiba Rinkan Hospital 7-9-1 Kami-tsuruma, Minami-ku, Sagamihara, Kanagawa, 252-0385 Japan
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Aulinas A, Valassi E, Webb SM. Pronóstico del paciente tratado de síndrome de Cushing. ACTA ACUST UNITED AC 2014; 61:52-61. [DOI: 10.1016/j.endonu.2013.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/07/2013] [Accepted: 03/11/2013] [Indexed: 10/26/2022]
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Ragnarsson O, Johannsson G. Cushing's syndrome: a structured short- and long-term management plan for patients in remission. Eur J Endocrinol 2013; 169:R139-52. [PMID: 23985132 DOI: 10.1530/eje-13-0534] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One hundred years have passed since Harvey Williams Cushing presented the first patient with the syndrome that bears his name. In patients with Cushing's syndrome (CS), body composition and lipid, carbohydrate and protein metabolism are dramatically affected and psychopathology and cognitive dysfunction are frequently observed. Untreated patients with CS have a grave prognosis with an estimated 5-year survival of only 50%. Remission can be achieved by surgery, radiotherapy and sometimes with medical therapy. Recent data indicate that the adverse metabolic consequences of CS are present for years after successful treatment.In addition, recent studies have demonstrated that health-related quality of life and cognitive function are impaired in patients with CS in long-term remission. The focus of specialised care should therefore be not only on the diagnostic work-up and the early postoperative management but also on the long-term follow-up. In this paper, we review the long-term consequences in patients with CS in remission with focus on the neuropsychological effects and discuss the importance of these findings for long-term management. We also discuss three different phases in the postoperative management of surgically-treated patients with CS, each phase distinguished by specific challenges: the immediate postoperative phase, the glucocorticoid dose tapering phase and the long-term management. The focus of the long-term specialised care should be to identify cognitive impairments and psychiatric disorders, evaluate cardiovascular risk, follow pituitary function and detect possible recurrence of CS.
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Affiliation(s)
- Oskar Ragnarsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
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49
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Cushing's disease in 2012. ACTA ACUST UNITED AC 2013; 61:93-9. [PMID: 24041670 DOI: 10.1016/j.endonu.2013.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/06/2013] [Accepted: 05/15/2013] [Indexed: 11/20/2022]
Abstract
The aim of this study was to review the literature published and the most important papers presented to meetings on Cushing's disease from October 2011 to September 2012. The selection has been performed according to the authors' criteria. Articles have been classified into five groups: quality of life and perception of the disease, clinical features and pathophysiology, comorbidity conditions, diagnosis, and treatment. The results and conclusions of each publication are discussed.
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Fallo F, Famoso G, Capizzi D, Sonino N, Dassie F, Maffei P, Martini C, Paoletta A, Iliceto S, Tona F. Coronary microvascular function in patients with Cushing's syndrome. Endocrine 2013; 43:206-13. [PMID: 22851333 DOI: 10.1007/s12020-012-9764-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
Abstract
The aim of the study was to evaluate patients with Cushing's syndrome the coronary flow reserve (CFR), an index of coronary microvascular function. Fifteen newly diagnosed patients with Cushing's syndrome (1 male/14 females; mean age 45 ± 11 years), were selected for having no clinical evidence of ischemic heart disease. Twelve patients had pituitary-dependent Cushing's disease and three had an adrenal adenoma. Fifteen subjects matched for age, sex, and major cardiovascular risk factors were used as controls. Coronary flow velocity in the left anterior descending coronary artery was investigated by transthoracic Doppler echocardiography at rest and during adenosine infusion. CFR was obtained as the ratio hyperemic/resting diastolic flow velocity. A reduced coronary reserve (hyperemic/resting ratio ≤ 2.5) was found in 5/15 Cushing patients and 4/15 controls. In all patients with abnormal CFR, epicardial coronary stenosis was excluded by multi-slice computed tomographic coronary angiography. CFR was inversely related to urinary cortisol in patients with endogenous hypercortisolism (Spearman's rho = -0.57, P = 0.03), while no correlation was found in controls. Coronary microvascular function, as assessed by CFR, is pathologically reduced in a considerable number of patients with Cushing's syndrome without clinical symptoms of ischemic heart disease and in the absence of epicardial coronary artery lesions, as well as in controls matched for cardiovascular risk factors. The presence of comorbidities can explain this early coronary abnormality in both patients and controls. Whether urinary cortisol may be a predictor of coronary microvascular function in the setting of patients with Cushing's syndrome, needs further investigation.
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Affiliation(s)
- Francesco Fallo
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
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