Blood pressure in pediatric patients with Cushing syndrome.
BACKGROUND
Hypertension (HTN) has been reported in up to 60% of children with Cushing syndrome (CS), but its course, side effects, and potential differences among various causes of CS have not been adequately studied.


OBJECTIVE
The objective of the study was to measure blood pressure in pediatric patients with CS before and after transphenoidal surgery or adrenalectomy and identify side effects and rates of residual HTN.


METHODS
Data from 86 children with corticotropinomas [Cushing disease (CD)] and 27 children with ACTH-independent CS (AICS) were analyzed.


RESULTS
Patients with CD and AICS had significant HTN before surgery; more patients with AICS had systolic HTN (SHTN) than with CD (74 vs. 44%, P = 0.0077), but the rate of diastolic HTN (DHTN) was similar. Both groups experienced significant decreases in SHTN immediately after transphenoidal surgery and adrenalectomy. One year postoperatively, both SHTN and DHTN were lower than the preoperative values in all patients, but as many as 16 and 4% of the patients with CD and 21 and 5% of the patients with AICS still had SHTN and DHTN, respectively. Higher blood pressure preoperatively correlated with cortisol levels. Two patients suffered serious side effects: one with multiple infarcts and another with hypertensive encephalopathy.


CONCLUSIONS
Children with CS are at risk for residual HTN despite a significant improvement after surgical cure. HTN appears to correlate with the degree of hypercortisolemia. Serious HTN-related side effects, although rare, may occur during the perioperative period.
Lodish
Maya B
MB
Section on Endocrinology Genetics, Program on Developmental Endocrinology Genetics, National Institute of Child Health and Human Development, NIH, Building 10, CRC, 10 Center Drive, MSC1103, Bethesda, Maryland 20892, USA. lodishma@mail.nih.gov
Sinaii
Ninet
N
Patronas
Nicholas
N
Batista
Dalia L
DL
Keil
Meg
M
Samuel
Jonelle
J
Moran
Jason
J
Verma
Somya
S
Popovic
Jadranka
J
Stratakis
Constantine A
CA
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003480:Cushing Syndrome / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult
D000324:Adrenocorticotropic Hormone