title: The hypertension of Cushing's syndrome: controversies in the pathophysiology and focus on cardiovascular complications.
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.
authors.affiliation: aDepartment of Experimental Medicine, Sapienza University of Rome bUnit of Endocrinology, Università Cattolica del Sacro Cuore, Rome cDipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples dNeuroendocrinology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Isidori
authors.forename: Chiara
authors.initials: C
authors.lastname: Graziadio
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Paragliola
authors.forename: Alessia
authors.initials: A
authors.lastname: Cozzolino
authors.forename: Alberto G
authors.initials: AG
authors.lastname: Ambrogio
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Corsello
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
mesh_terms: D000818:Animals; D001794:Blood Pressure; D003480:Cushing Syndrome / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005938:Glucocorticoids / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology
chemical_list: D005938:Glucocorticoids