Soluble adhesion molecules levels in patients with Cushing's syndrome before and after cure.
OBJECTIVE
Patients with Cushing's syndrome (CS) show a high prevalence of cardiovascular risk factors and atherosclerosis, persisting even after cure. Soluble intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) are surrogate markers of endothelial function involved in the initiation of atherosclerosis. This study aimed to evaluate sICAM-1 and sVCAM-1 levels in patients with CS before and after successful cure.


METHODS
sICAM-1 and sVCAM-1 levels were evaluated in 28 patients with active CS and in 12 patients with Cushing's disease (CD), 6-12 months after disease remission. Body mass index (BMI), blood pressure, glucose, serum lipids, ACTH, cortisol and urinary free cortisol (UFC) were measured in basal conditions in all patients.


RESULTS
At baseline, sICAM-1 levels positively correlated with BMI (r=0.443, p<0.01), while no correlations between sICAM/sVCAM levels and ACTH, cortisol or UFC were found. Plasma ACTH, serum cortisol, and UFC levels significantly decreased in 12 cured patients, but ICAM-1 and VCAM-1 levels were unchanged (12.7+/-1.8 vs 10.1+/-0.9 ng/ml and 33.5+/-4.4 vs 35.8+/-4.0 ng/ml, respectively). Obesity, hypertension, and impaired glucose metabolism persisted 1 yr after the biochemical cure of hypercortisolism. A significant reduction in ICAM-1 levels was observed in 4 out of 12 cured patients as well as a remission from diabetes, hypertension or obesity.


CONCLUSIONS
ICAM/VCAM-1 levels show a great variability in patients with active CS, not correlated with cortisol levels, and are slightly modified in some cured patients with CD. The persistence of obesity, hypertension, and impaired glucose metabolism may be responsible for the maintenance of a subclinical endothelial dysfunction, making these subjects still at high cardiovascular risk and needing a long-term follow-up.
Endocrinology Unit, Department of Medical and Surgical Sciences, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
F
F
Ermetici
A E
AE
Malavazos
S
S
Corbetta
C
C
Eller-Vainicher
S
S
Cannavò
M M
MM
Corsi
B
B
Ambrosi
D000236:Adenoma / Q000150:complications / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D015992:Body Mass Index; D015815:Cell Adhesion Molecules / Q000097:blood*; D003480:Cushing Syndrome / Q000097:blood* / Q000209:etiology / Q000601:surgery* / Q000652:urine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012995:Solubility; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D015815:Cell Adhesion Molecules; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone