PDF herunterladen
Horm Metab Res 2007; 39(12): 908-914
DOI: 10.1055/s-2007-992813
Humans, Clinical

© Georg Thieme Verlag KG Stuttgart · New York

Circadian Blood Pressure Profile in Patients with Active Cushing's Disease and after Long-term Cure

F. Pecori Giraldi 1 , P. M. Toja 1 , M. De Martin 1 , A. Maronati 2 , M. Scacchi 1 , S. Omboni 2 , F. Cavagnini 1 , G. Parati 2
  • 1Chair of Endocrinology, University of Milan, Ospedale San Luca, Instituto Auxologico Italiano IRCCS, Milan, Italy
  • 2Department of Clinical Medicine and Prevention, University of Milano-Bicocca; Department of Cardiology, Ospedale San Luca, Instituto Auxologico Italiano IRCCS, Milan, Italy
Weitere Informationen

Publikationsverlauf

received 12.02.2007

accepted 24.04.2007

Publikationsdatum:
28. November 2007 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Hypertension is a major feature of Cushing's disease, with the attendant increase in the rate of cardiovascular events. The circadian blood pressure profile also impacts cardiovascular risk and a few studies have shown that patients with Cushing's syndrome do not present the expected nocturnal blood pressure decrease and, further, that this alteration persists in short-range disease remission. These studies were performed by conventional discontinuous ambulatory pressure monitoring, a technique not devoid of limitations. Aim of our study was the assessment of blood pressure and heart rate profile by beat-to-beat noninvasive monitoring in twelve patients with active Cushing's disease (9 women and 3 men, age 33.3±2.36 years) and the assessment of its possible changes at short- (<1 year) and long-term (2-3 years) follow-up after curative surgery. No nocturnal blood pressure dipping (i.e., decrease by 10% of daytime values) was observed in 50% of patients both during active hypercortisolism and within 1 year from surgery. Recovery of blood pressure dipping profile was detected at long-term follow-up in a minority of patients. Daytime heart rate was higher in patients with active Cushing's disease and decreased over time after cure. In conclusion, patients with Cushing's disease present absent nocturnal blood pressure dipping and abnormal heart rate values which do not resolve after short-term remission of hypercortisolism and show only partial improvement in the long run. These findings identify additional cardiovascular risk factors for patients cured of Cushing's disease.

Key words

hypertension - cardiovascular risk - blood pressure dipping - hypercortisolism - treatment

References

  • 1 Plotz CM, Knowlton AL, Ragan C. The natural history of Cushing's syndrome.  Am J Med. 1952;  13 577-614
    PubMedSuche in Google Scholar
  • 2 Ross EJ, Linch DC. The clinical response to treatment in adult Cushing's syndrome following remission of hypercortisolaemia.  Postgrad Med J. 1985;  61 205-211
    PubMedSuche in Google Scholar
  • 3 Welbourn RB. Survival and causes of death after adrenalectomy for Cushing's disease.  Surgery. 1985;  97 16-20
    PubMedSuche in Google Scholar
  • 4 Grabner P, Hauer-Jensen M, Jervell J, Flatmark A. Long term results of treatment of Cushing's disease by adrenalectomy.  Eur J Surg. 1991;  157 461-464
    PubMedSuche in Google Scholar
  • 5 Lindholm J, Juul S, Jørgensen JOL, Astrup J, Bjerre P, Feldt-Rasmussen U, Hagen C, Jørgensen J, Kosteljanetz M, Kristensen LØ, Laurberg P, Schmidt K, Weeke J. Incidence and late prognosis of Cushing's syndrome: a population-based study.  J Clin Endocrinol Metab. 2001;  86 117-123
    CrossrefPubMedSuche in Google Scholar
  • 6 Swearingen B, Biller BMK, Barker FG, Katznelson L, Grinspoon S, Klibanski A, Zervas NT. Long-term mortality after transsphenoidal surgery for Cushing disease.  Ann Intern Med. 1999;  130 821-824
    CrossrefPubMedSuche in Google Scholar
  • 7 Pikkarainen L, Sane T, Reunanen A. The survival and well-being of patients treated for Cushing's syndrome.  J Intern Med. 1999;  245 463-468
    CrossrefPubMedSuche in Google Scholar
  • 8 Fallo F, Sonino N, Barzon L, Pistorello M, Pagotto U, Paoletta A, Boscaro M. Effect of surgical treatment on hypertension in Cushing's syndrome.  Am J Hypertens. 1995;  9 77-80
    PubMedSuche in Google Scholar
  • 9 Colao A, Pivonello R, Spiezia S, Faggiano A, Ferone D, Filippella M, Marzullo P, Cerbone G, Siciliani M, Lombardi G. Persistence of increased cardiovascular risk in patients with Cushing's disease after five years of successful cure.  J Clin Endocrinol Metab. 1999;  84 2664-2672
    CrossrefPubMedSuche in Google Scholar
  • 10 Mancia G, Zanchetti A, Agabiti Rosei E, Benemio G, Cesaris R De, Fogari R, Pessina A, Porcellati C, Rappelli A, Salvetti A, Trimarco B. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. SAMPLE study group.  Circulation. 1997;  95 1464-1470
    CrossrefPubMedSuche in Google Scholar
  • 11 Staessen JA, Asmar R, Buyzere M De, Imai Y, Parati G, Shimada K, Stergiou G, Redón J, Verdecchia P. Task force II: blood pressure measurement and cardiovascular outcome.  Blood Press Monit. 2001;  6 355-370
    CrossrefPubMedSuche in Google Scholar
  • 12 Verdecchia P. Prognostic value of ambulatory blood pressure.  Hypertension. 2000;  35 844-851
    PubMedSuche in Google Scholar
  • 13 Mancia G, Parati G, Rienzo M Di, Zanchetti A. Pathophysiology of hypertension. In: Zanchetti A, Mancia G (eds) Handbook of Hypertension. Philadelphia: Elsevier Science 1997: 117-169
    Suche in Google Scholar
  • 14 Verdecchia P, Schillaci G, Porcellati C. Dippers versus non-dippers.  J Hypertension. 1991;  9 ((Suppl 8)) S42-S44
    PubMedSuche in Google Scholar
  • 15 Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B, Lonati L, Magrini F, Zanchetti A. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure.  J Hypertension. 2004;  22 273-280
    PubMedSuche in Google Scholar
  • 16 O'Brien E, Sheridan J, O'Malley K. Dippers and non-dippers.  Lancet. 1988;  2 397
    PubMedSuche in Google Scholar
  • 17 Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F, Porcellati C. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension.  Circulation. 1990;  81 528-536
    CrossrefPubMedSuche in Google Scholar
  • 18 Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakapoulos N. Impact of obesity on 24-hour ambulatory blood pressure and hypertension.  Hypertension. 2005;  45 602-607
    CrossrefPubMedSuche in Google Scholar
  • 19 Björklund K, Lind L, Andrén B, Lithell H. The majority of nondipping men do not have increased cardiovascular risk: a population-based study.  J Hypertension. 2002;  20 1501-1508
    PubMedSuche in Google Scholar
  • 20 Myers MG. Twenty-four-hour blood pressure control: a brief review of aspects of target-organ protection.  J Hypertens Suppl. 1996;  14 S7-S10
    PubMedSuche in Google Scholar
  • 21 Plaschke M, Trenkwalder P, Dahlheim H, Lechner C, Trenkwalder C. Twenty-four-hour blood pressure profile and blood pressure responses to head-up tilt tests in Parkinson's disease and multiple system atrophy.  J Hypertension. 1998;  16 1433-1441
    PubMedSuche in Google Scholar
  • 22 Imai Y, Abe K, Sasaki S, Minami N, Nihei M, Munakata M, Murakami O, Matsue K, Sekino H, Miura Y, Yoshinaga K. Altered circadian blood pressure rhythm in patients with Cushing's syndrome.  Hypertension. 1988;  12 11-19
    PubMedSuche in Google Scholar
  • 23 Zacharieva S, Orbetzova M, Stoynev A, Shigarminova R, Yaneva M, Kalinov K, Nachev E, Elenkova A. Circadian blood pressure profile in patients with Cushing's syndrome before and after treatment.  J Endocrinol Invest. 2004;  27 924-930
    PubMedSuche in Google Scholar
  • 24 Manning G, Rushton L, Donnelly R, Millar-Craig MW. Variability of diurnal changes in ambulatory blood pressure and nocturnal dipping status in untreated hypertensive and normotensive subjects.  Am J Hypertens. 2000;  13 1035-1038
    CrossrefPubMedSuche in Google Scholar
  • 25 Omboni S, Parati G, Palatini P, Vanasia A, Muiesan ML, Cuspidi C, Mancia G. Reproducibility and clinical value of nocturnal hypotension: prospective evidence from the SAMPLE study.  J Hypertension. 2006;  16 733-738
    PubMedSuche in Google Scholar
  • 26 Imholz BP, Langewouters GJ, Montfrans GA von, Parati G, Goudoever J van, Wesseling KH, Wieling W, Mancia G. Feasibility of ambulatory, continuous 24-hour finger arterial pressure recording.  Hypertension. 1993;  21 65-73
    PubMedSuche in Google Scholar
  • 27 Invitti C, Pecori Giraldi F, Martin M De, Cavagnini F. the Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis . Diagnosis and management of Cushing's syndrome: results of an Italian multicentre study.  J Clin Endocrinol Metab. 1999;  84 440-448
    CrossrefPubMedSuche in Google Scholar
  • 28 Guidelines Committee . European Society of Hypertension - European Society of Cardiology guidelines for the management of arterial hypertension.  J Hypertension. 2003;  21 1011-1053
    PubMedSuche in Google Scholar
  • 29 Parati G, Casadei R, Groppelli A, Di Rienzo M, Mancia G. Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing.  Hypertension. 1989;  13 647-655
    CrossrefPubMedSuche in Google Scholar
  • 30 Omboni S, Parati G, Castiglioni P, Di Rienzo M, Imholz BP, Langewouters GJ, Wesseling KH, Mancia G. Estimation of blood pressure variability from 24-hour ambulatory finger blood pressure.  Hypertension. 1998;  32 52-58
    PubMedSuche in Google Scholar
  • 31 Gizdulich P, Imholz BP, Meiracker AH van den, Parati G, Wesseling KH. Finapres tracking of systolic pressure and baroreflex sensitivity improved by waveform filtering.  J Hypertension. 1996;  14 243-250
    PubMedSuche in Google Scholar
  • 32 Westerhof BE, Guelen I, Parati G, Groppelli A, Montfrans GA van, Wieling W, Wesseling KH, Bos WJ. Variable day/night bias in 24-h non-invasive finger pressure against intrabrachial artery pressure is removed by waveform filtering and level correction.  J Hypertension. 2002;  20 1981-1986
    PubMedSuche in Google Scholar
  • 33 Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Telera MP, Pede S, Gattobigio R, Porcellati C. Adverse prognostic value of blunted circadian rhythm of heart rate in essential hypertension.  J Hypertension. 1998;  16 1335-1343
    PubMedSuche in Google Scholar
  • 34 Gardner MJ, Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing.  Br Med J. 1986;  292 746-750
    PubMedSuche in Google Scholar
  • 35 Erdogan D, Gullu H, Caliskan M, Yildirim I, Baycan S, Ciftici C, Muderrisoglu H. The influence of circadian blood pressure changes on aortic distensibility and left ventricular diastolic function in hypertensive individuals.  Int J Cardiovasc Imaging. 2006;  22 157-165
    CrossrefPubMedSuche in Google Scholar
  • 36 Tsivgoulis G, Vemmos KN, Zakopoulos N, Spengos K, Manios E, Sofia V, Zis V, Mavrikakis M. Association of blunted nocturnal blood pressure dip with intracerebral hemorrhage.  Blood Press Monit. 2005;  10 189-195
    CrossrefPubMedSuche in Google Scholar
  • 37 Ohkubo T, Imai Y, Tsuji I, Nagai K, Watanabe N, Minami N, Kato J, Kikuchi N, Nishiyama A, Aihara A, Sekino M, Satoh H, Hisamichi S. Relation between nocturnal decline in blood pressure and mortality. The Osahama study.  Am J Hypertens. 1997;  10 1201-1207
    CrossrefPubMedSuche in Google Scholar
  • 38 Nakano S, Fukuda M, Hotta F, Ito T, Ishii T, Kitazawa M, Nishiwama M, Kigoshi T, Uchida K. Reverse circadian blood pressure rhythm is associated with occurrences of both fatal and non fatal vascular events in NIDDM subjects.  Diabetes. 1998;  47 1501-1506
    CrossrefPubMedSuche in Google Scholar
  • 39 Stella P, Tabak AG, Zgibor JC, Orchard TJ. Late diabetes complications and non-dipping phenomenon in patients with type 1 diabetes.  Diabetes Res Clin Pract in. 2006;  71 14-20
    PubMedSuche in Google Scholar
  • 40 Sherwood A, Steffen PR, Blumenthal JA, Kuhn C, Hinderliter AL. Nighttime blood pressure dipping: the role of the sympathetic nervous system.  Am J Hypertens. 2002;  15 111-118
    CrossrefPubMedSuche in Google Scholar
  • 41 Staessen JA, Birkenhager W, Bulpitt CJ, Fagard R, Fletcher AE, Lijnen P, Thijs L, Amery A. The relationship between blood pressure and sodium and potassium excretion during the day and at night.  J Hypertension. 1993;  11 443-447
    PubMedSuche in Google Scholar
  • 42 Noda A, Okada T, Hayashi H, Yasuma F, Yokota M. 24-hour ambulatory blood pressure variability in obstructive sleep apnoea syndrome.  Chest. 1993;  103 1343-1347
    CrossrefPubMedSuche in Google Scholar
  • 43 Parati G. Blood pressure reduction at night: sleep and beyond.  J Hypertension. 2000;  18 1725-1729
    PubMedSuche in Google Scholar
  • 44 Imai Y, Abe K, Sasaki S, Minami N, Munakata M, Nihei M, Sekino H, Yoshinaga K. Exogenous glucocorticoid eliminates or reverses circadian blood pressure variations.  J Hypertension. 1989;  7 113-120
    PubMedSuche in Google Scholar
  • 45 Fallo F, Fanelli G, Cipolla A, Betterle C, Boscaro M, Sonino N. 24-hour blood pressure profile in Addison's disease.  Am J Hypertens. 2006;  7 1105-1109
    PubMedSuche in Google Scholar
  • 46 Matsumara K, Abe I, Fukuhara M, Fujii K, Ohya Y, Okamura K, Fujishima M. Modulation of circadian rhythm of blood pressure by cortisol in patients with hypopituitarism.  Clin Exp Hypertens. 2006;  16 55-66
    PubMedSuche in Google Scholar
  • 47 Panarelli M, Terzolo M, Piovesan A, Osella G, Paccotti P, Pinna G, Angeli A. 24-hour profiles of blood pressure and heart rate in Cushing's syndrome.  Ann Ital Med Int. 1990;  5 18-25
    PubMedSuche in Google Scholar
  • 48 Kreze A, Mikulecky M. Daily blood pressure profile in Cushing's syndrome before and after surgery.  Braz J Med Biol Res. 1999;  32 1199-1203
    PubMedSuche in Google Scholar
  • 49 Zelinka T, Strauch B, Pecen L, Widimisky Jr J. Diurnal blood pressure variation in pheochromocytoma, primary aldosteronism and Cushing's syndrome.  J Hum Hypertension. 2004;  18 107-111
    PubMedSuche in Google Scholar
  • 50 Palatini P, Julius S. Elevated heart rate: a major risk factor for cardiovascular disease.  Clin Exp Hypertens. 2004;  26 637-644
    CrossrefPubMedSuche in Google Scholar
  • 51 Cushing H. The basophil adenomas of the pituitary body and their clinical manifestations.  Johns Hopkins Bull. 1932;  50 137-195
    PubMedSuche in Google Scholar
  • 52 Hermus AR, Huysmans DA, Smals AGH, Corstens FH, Kloppenborg PWC. Remarkable improvement of osteopenia after cure of Cushing's syndrome.  Horm Metab Res. 1994;  26 209-210
    Thieme ConnectPubMedSuche in Google Scholar
  • 53 Suzuki T, Shibata H, Ando T, Kurihara I, Kobayashi S, Hayashi K, Hayashi M, Kawabe H, Saito I, Murai M, Saruta T. Risk factors associated with persistent postoperative hypertension in Cushing's syndrome.  Endocrine Res. 2000;  26 791-795
    PubMedSuche in Google Scholar
  • 54 Reinartz G, Angermaier A, Buchfelder M, Fahlbusch R, Georgieff M. Cushing's disease utilizing stable isotope techniques.  Horm Metab Res. 1995;  27 425-431
    Thieme ConnectPubMedSuche in Google Scholar
  • 55 Pivonello R, Faggiano A, Lombardi G, Colao A. The metabolic syndrome and cardiovascular risk in Cushing's syndrome.  Endocrinol Metab Clin North Am. 2005;  34 327-339
    CrossrefPubMedSuche in Google Scholar
  • 56 Lindsay JR, Nansel T, Baid S, Gumowski J, Nieman LK. Long-term impaired quality of life in Cushing's syndrome despite initial improvement after surgical remission.  J Clin Endocrinol Metab. 2005;  91 447-453
    CrossrefPubMedSuche in Google Scholar
  • 57 Pecori Giraldi F, Andrioli M, Marinis L De, Bianchi A, Giampietro A, Martin M De, Sacco E, Scacchi M, Pontercorvi AS, Cavagnini F. Significant GH deficiency after long-term cure by surgery in adult patients with Cushing's disease.  Eur J Endocrinol. 2007;  156 235-241
    PubMedSuche in Google Scholar
  • 58 Palatini P, Parati G. Modulation of 24-h blood pressure profiles: a new target for treatment?.  J Hypertension. 2005;  23 1799-1801
    PubMedSuche in Google Scholar

Correspondence

Prof. F. Cavagnini

Chair of Endocrinology

University of Milan

Ospedale San Luca

via Spagnoletto 3

20149 Milan

Italy

Telefon: +39/02/61911 27 38

Fax: +39/02/61911 27 77

eMail: cavagnini@auxologico.it