Cardiovascular and cerebrovascular complications and clinical characteristics in patients with Cushing's syndrome of different aetiologies

Abstract

Objective To compare the cardiovascular and cerebrovascular complications and clinical characteristics in patients with Cushing's syndrome of various aetiologies.Methods Two hundred and eighty-four consecutive patients with Cushing's syndrome were included and divided into three groups according to aetiologies:Cushing's disease group (CD),adrenal adenoma group (AA),ectopic ACTH syndrome group (EAS).Results (1) Of the 284 patients,the mean age was(37.7 ± 12.3) years(16-76 years),while in EAS group it was(45.1 ±16.4) years (16-68 years,P ＜0.05).Patients in EAS group had shorter duration of illness (1-3 months).Hypokalemia was present in 44.9％,32.3％,100％ of patients in CD group,AA group,and EAS group respectively.(2) Patients in EAS group were more susceptible to alkalosis and edema of lower limbs,and had lower prevalence of striae (P＜0.05) ; AA group had lower prevalence of pigmentation and acne(P＜0.01).(3) Patients in EAS group had significantly higher baseline plasma ACTH,cortisol,and 24 h urine free cortisol levels than those in CD group and AA group.(4) Patients in EAS group and CD group had similar prevalences of overall vascular complications(68.8％ vs 59.2％,P＞0.05),which were significantly higher than that in AA group(43.4％,P＜0.05).Compared with AA group,patients in CD group had higher prevalence of cardiovascular complications (43.8％ vs 31.3％) and cerebrovascular complications (13.1％ vs 6.1％,P＜0.05),manifesting as cardiac arrhythmia(33.7％ vs 22.2％) and cerebral infarction (13.1％ vs 5.1％,P ＜0.05).No significant difference in the prevalence of impaired renal function in three groups was found (P ＞ 0.05).Multivariate logistic regression analysis revealed that the incidence of hypokalemia was positively correlated with vascular complication in group CD,but serum potassium level was negatively correlated with vascular complication.Conclusion Patients in EAS group were older and had shorter duration of illness,and higher levels of hormone,and were more susceptible to hypokalemia,alkalosis edema of lower limbs,and pigmentation.Patients in CD group had higher prevalence of cardiovascular and cerebrovascular complications than that in AA group,especially arrhythmias and cerebral infarction.No significant difference in the incidence of impaired renal function was found among three groups.Hypokalemia might be the independent risk factor of vascular complications in CD group. Key words: Cushing's syndrome; Hypokalemia; Vascular complications; Different aetiologies