Cardiovascular evaluation and endothelial dysfunction in Cushing syndrome following remission: a prospective study

Hacioglu A., Firat S. T., Caglar A. S., Karaca Z. C., Kalay N., Taheri S., ...More

JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, vol.47, no.3, pp.645-653, 2024 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 47 Issue: 3
  • Publication Date: 2024
  • Doi Number: 10.1007/s40618-023-02183-4
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CAB Abstracts
  • Page Numbers: pp.645-653
  • Keywords: Cushing syndrome, Endothelin-1, Interleukin-1, Tumor necrosis factor-alpha
  • Erciyes University Affiliated: Yes


Purpose Cushing syndrome (CS) is a well-known risk factor for cardiovascular morbidities. We aimed to evaluate endothelial and cardiovascular functions, endothelial mediators and pro-inflammatory cytokines in patients with CS before and after remission. Methods Adult patients with newly diagnosed endogenous CS were included. Metabolic [body mass index (BMI), glucose, and lipid values] and cardiovascular evaluation studies [24-h ambulatory blood pressure monitoring, carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and echocardiography] were performed, and endothelial mediators [asymmetric dimethyl arginine (ADMA) and endothelin-1 ( ET-1)] and pro-inflammatory cytokines [interleukin-1 ss (IL-1 ss) and tumor necrosis factor-alpha (TNF-alpha)] were measured. Control group was matched in terms of age, gender, and BMIs. Results Twenty-five patients, mean age 40.60 +/- 14.04 years, completed the study. Compared to controls (n = 20) mean arterial pressure (MAP) and CIMT were higher (p < 0.005 and p = 0.012, respectively), and FMD (p < 0.001) and mitral E/A ratio (p = 0.007) lower in the patients during active disease. Baseline serum ADMA, ET-1, and IL-1 ss were similar between the groups, while TNF-alpha was lower in the patients (p = 0.030). All patients were in complete remission 1 year following surgery. BMI, LDL cholesterol, serum total cholesterol, fasting plasma glucose, MAPs, and CIMT significantly decreased (p < 0.005), while there was no improvement in FMD (p = 0.11) following remission. There was no significant change in ADMA, IL-1 ss, and TNF-a levels, but ET-1 increased (p = 0.011). Conclusions Remission in CS improves some cardiovascular parameters. ADMA and ET-1 are not reliable markers for endothelial dysfunction in CS. Metabolic improvements may not directly reflect on serum concentrations of TNF-alpha and IL-1 ss following remission of CS.