Goran Koraćević, Miloš Zdravković, Maja Koraćević, Dimitrije A. Pavlović, Miodrag Damjanović, Milorad Pavlović, Sonja Dakić, Predrag Cvetković, Katarina Mladenović, Milan Stojković

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Numerous studies and reviews agree about the increased cardiovascular risk in Cushing’s syn-drome. Therefore, the aim of the paper is to suggest a few common diagnostic and therapeutic cardiologic preferences for the majority of Cushing’s syndrome/Cushing’s disease (CS/CD) pa-tients which are not yet routine but have the rationale to become standard procedures. This may serve as an initial working document, to be improved by the experts in the field. A narrative review is used to present synthesis and deduction of several approaches in cardiology regarding the actu-al topic. Results are systematized as the risk factors or co-morbidities list (prevalent in CS/CD) coupled with current and adapted cardiologic suggestions for practice.


Cushing's syndrome, Cushing's disease, ACE inhibitor, spironolactone, statin, holter monitoring

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Fleseriu M. Salivary Cortisol in the Diagnosis of Cushing Syndrome, Always More Than One! J Endocr Soc 2020; 4(10):bvaa109. doi: 10.1210/jendso/bvaa109.

Chaudhry HS, Singh G. Cushing Syndrome. Treasure Island (FL): StatPearls Publishing, 2020. PMID: 29261900

Nguyen HCT, Anastasopoulou C. Iatrogenic Cushing Syndrome. Downloaded from: https://emedicine.medscape.com/article/

-overview (1/11/2021).

Suarez MG, Stack M, Hinojosa-Amaya JM, et al. Hypercoagulability in Cushing Syndrome, Prevalence of Thrombotic Events: A Large, Single-Center, Retrospective Study. J Endocr Soc 2019; 4(2):bvz033. doi: 10.1210/jendso/bvz033. PMID: 32064411;

Koracevic G, Stojkovic M, Lovic D, et al. Should Cushing's Syndrome be Considered as a Disease with High Cardiovascular Risk in Relevant Guidelines? Curr Vasc Pharmacol 2020; 18(1):12-24. doi: 10.2174/1570161116666181005122339.

Ragnarsson O, Olsson DS, Papakokkinou E, et al. Overall and Disease-Specific Mortality in Patients With Cushing Disease: A Swedish Nationwide Study. J Clin Endocrinol Metab 2019; 104(6):2375-2384. doi: 10.1210/jc.2018-02524. PMID: 30715394.

De Leo M, Pivonello R, Auriemma RS, et al. Cardiovascular disease in Cushing's syndrome: heart versus vasculature. Neuroendocrinology 2010; 92 Suppl 1:50-54. doi: 10.1159/000318566.

Peppa M, Krania M, Raptis SA. Hypertension and other morbidities with Cushing's syndrome associated with corticosteroids: a review. Integr Blood Press Control 2011; 4:7-16. doi: 10.2147/IBPC.S9486.

Williams B, Mancia G, Spiering W, et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39(33):3021-3104. doi: 10.1093/


Umemura S, Arima H, Arima S, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2019; 42(9):1235-1481. doi: 10.1038/s41440-019-0284-9.

Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension 2020; 75(6):1334‐1357. doi:10.1161/HYPERTENSIONAHA.


Koracevic G, Stojanovic M, Stojanovic S, Lovic D, Djordjevic M. Rationale to search for masked hypertension in severe Cushing’s disease. Minerva Med (accepted for publication)

Ferriere A, Tabarin A. Cushing's syndrome: Treatment and new therapeutic approaches. Best Pract Res Clin Endocrinol Metab 2020; 34(2):101381. doi: 10.1016/j.beem.2020.101381.

Magiakou MA, Smyrnaki P, Chrousos GP. Hypertension in Cushing's syndrome. Best Pract Res Clin Endocrinol Metab 2006; 20(3):467-482. doi: 10.1016/j.beem.2006.07.006.

Cicala MV, Mantero F. Hypertension in Cushing's syndrome: from pathogenesis to treatment. Neuroendocrinology 2010; 92 Suppl 1:44-49. doi: 10.1159/000314315.

Barbot M, Ceccato F, Scaroni C. The Pathophysiology and Treatment of Hypertension in Patients With Cushing's Syndrome. Front Endocrinol (Lausanne) 2019;10:321. doi: 10.3389/fendo.2019.00321.

Rebellato A, Grillo A, Dassie F, et al. Ambulatory blood pressure monitoring-derived short-term blood pressure variability is increased in Cushing's syndrome. Endocrine 2014; 47(2):557-563. doi: 10.1007/s12020-014-0164-7.

Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34(28):2159-2219. doi: 10.1093/eurheartj/eht151.

Fallo F, Sonino N. Should we evaluate for cardiovascular disease in patients with Cushing's syndrome? Clin Endocrinol (Oxf) 2009; 71(6):768-771. doi: 10.1111/j.1365-2265.2009.03610.x.

Ko DT, Sivaswamy A, Sud M, et al. Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations CMAJ 2020; 192(17):E442-E449. doi: 10.1503/cmaj.190848.

Al-Shamsi S. Performance of the Framingham coronary heart disease risk score for predicting 10-year cardiac risk in adult United Arab Emirates nationals without diabetes: a retrospective cohort study. BMC Fam Pract 2020; 21(1):175. doi: 10.1186/


Bruckert E, Parhofer KG, Gonzalez-Juanatey JR, et al. Proportion of High-Risk/Very High-Risk Patients in Europe with Low-Density Lipoprotein Cholesterol at Target According to European Guidelines: A Systematic Review. Adv Ther 2020; 37(5):1724-1736. doi: 10.1007/s12325-020-01285-2.

Sheikh T, Shuja H, Zaidi SR, Haque A. Glucocorticoid-induced cardiomyopathy: unexpected conclusion. BMJ Case Rep 2020; 13(11):e237173. doi: 10.1136/bcr-2020-237173.

Seferovic PM, Ponikowski P, Anker SD, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21(10):1169-1186. doi: 10.1002/ejhf.1531.

Yancy CW, Jessup M, Bozkurt B,et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017; 136(6):e137-e161. doi: 10.1161/


Arnaldi G, Mancini T, Polenta B, Boscaro M. Cardiovascular risk in Cushing’s syndrome. Pituitary 2004; 7(4):253-256.

Ahn CH, Kim JH, Park MY, Kim SW. Epidemiology and Comorbidity of Adrenal Cushing's Syndrome: A Nationwide Cohort Study. J Clin Endocrinol Metab 2020:dgaa752. doi: 10.1210/clinem/dgaa752.

Reeh J, Therming CB, Heitmann M, et al. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J 2019;40(18):1426-1435. doi: 10.1093/eurheartj/ehy806.

Cainzos-Achirica M, Miedema MD, McEvoy JW, et al. Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019: The MESA Study (Multi-Ethnic Study of Atherosclerosis). Circulation 2020; 141(19):1541-1553. doi: 10.1161/CIRCULATIONAHA.119.

PMID: 32233663;

Park MY, Kim SW. Epidemiology and Comorbidity of Adrenal Cushing's Syndrome: A Nationwide Cohort Study. J Clin Endocrinol Metab 2020:dgaa752. doi: 10.1210/clinem/dgaa752.

Stewart J, Addy K, Campbell S, Wilkinson P. Primary prevention of cardiovascular disease: Updated review of contemporary guidance and literature. JRSM Cardiovasc Dis 2020;9:2048004020949326. doi: 10.1177/2048004020949326.

Koracevic G, Mićić S, Stojanović M, et al. High likelihood for atrial fibrillation in Cushing's syndrome. Eur Rev Med Pharmacol Sci 2020; 24(3):1391-1397. doi: 10.26355/


Langote A, Hiremath S, Ruzicka M, McCormick BB. Spironolactone is effective in treating hypokalemia among peritoneal dialysis patients. PLoS One 2017; 12(11):e0187269. doi: 10.1371/journal.pone.0187269.

Gilligan S, Raphael KL. Hyperkalemia and Hypokalemia in CKD: Prevalence, Risk Factors, and Clinical Outcomes. Adv Chronic Kidney Dis 2017; 24(5):315-318. doi: 10.1053/j.ackd.2017.06.004.

Koraćević G, Stojanović M, Petrović S, et al. Cushing’s syndrome, a risk factor for venous thromboembolism is a candidate for guidelines. Acta Endocrinol (Buchar) 2020; 16(2):123-128. doi: 10.4183/aeb.2020.123. PMID: 33029226

Konstantinides SV, Meyer G, Becattini C, et al.The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019; 54(3):1901647. doi: 10.1183/13993003.01647-2019.

Streiff MB, Agnelli G, Connors JM, et al. Guidance for the treatment of deep vein thrombosis and pulmonary embolism. J Thromb Thrombolysis 2016; 41(1):32-67. doi: 10.1007/s11239-015-1317-0

Qin L, Zhu X, Liu X,et al. Evaluation of lipid profile and its relationship with blood pressure in patients with Cushing's disease. Endocr Connect. 2018; 7(5):637-644. doi: 10.1530/EC-18-0010.

Barbot M, Zilio M, Scaroni C. Cushing's syndrome: Overview of clinical presentation, diagnostic tools and complications. Best Pract Res Clin Endocrinol Metab 2020; 34(2):101380. doi: 10.1016/j.beem.2020. PMID: 32165101

Pivonello R, De Martino MC, De Leo M, Simeoli C, Colao A. Cushing's disease: the burden of illness. Endocrine 2017; 56(1):10-18. doi: 10.1007/s12020-016-0984-8.

Feingold KR, Brinton EA, Grunfeld C. The Effect of Endocrine Disorders on Lipids and Lipoproteins. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc, 2000

Pivonello R, De Leo M, Cozzolino A, Colao A. The Treatment of Cushing's Disease. Endocr Rev 2015; 36(4):385-486. doi: 10.1210/er.2013-1048.

Minetto MA, Caresio C, Salvi M, et al. Ultrasound-based detection of glucocorticoid-induced impairments of muscle mass and structure in Cushing's disease. J Endocrinol Invest 2019; 42(7):757-768. doi: 10.1007/s40618-018-0979-9.

Pérez EG, Hernández EA, Zuñiga AE, et al. Comparación del índice de gravedad del síndrome de Cushing entre pacientes con origen endógeno y yatrogénico de la enfermedad [Comparison of the severity index in Cushing's syndrome between patients with endogenous and iatrogenic disease]. Endocrinol Nutr 2010; 57(9):426-433. doi: 10.1016/j.endonu.2010.06.011.

Surmachevska N, Tiwari V. Corticosteroid Induced Myopathy. Treasure Island (FL): StatPearls Publishing, 2020.

Dobkin BH. The insidious impact of under-diagnosed proximal weakness induced by statins. Expert Rev Neurother 2020:1-9. doi: 10.1080/14737175.2021.1866988.

Hey TM, Dahl JS, Brix TH, Søndergaard EV. Biventricular hypertrophy and heart failure as initial presentation of Cushing's disease. BMJ Case Rep 2013; 2013:bcr2013201307. doi: 10.1136/bcr-2013-201307.

Aydoğan Bİ, Gerede DM, Canpolat AG, Erdoğan MF. Cushing's Disease Presented by Reversible Dilated Cardiomyopathy. Case Rep Cardiol 2015; 2015:980897. doi: 10.1155/2015/980897.

Marchand L, Segrestin B, Lapoirie M, et al. Dilated Cardiomyopathy Revealing Cushing Disease: A Case Report and Literature Review. Medicine (Baltimore) 2015; 94(46):e2011. doi: 10.1097/MD.0000000000002011.

Ponikowski P, Voors AA, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Web Addenda 2016 Addenda Web Tables. Eur Heart J 2016 https://www.escardio.org/static_file/Escardio/Guidelines/ehw128_Addenda.pdf [March 21st, 2020.]

Koracevic G, Micic S, Stojanovic M, et al. Compelling Indications Should be Listed for Individual Beta-Blockers (Due to Diversity), Not for the Whole Class. Curr Vasc Pharmacology 2021, doi: 10.2174/1570161118666200518113833 (accepted for publication)

Roldán-Sarmiento P, Lam-Chung CE, Hinojosa-Amaya JM, et al. Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing's Disease Mortality: A Cohort Study. J Clin Endocrinol Metab 2021; 106(1):e103-e111. doi: 10.1210/clinem/


Orozco-Beltran D, Quesada JA, Bertomeu-Gonzalez V, et al. A new risk score to assess atrial fibrillation risk in hypertensive patients (ESCARVAL-RISK Project. Sci Rep 2020; 10(1):4796. doi: 10.1038/s41598-020-61437-w.

DOI: https://doi.org/10.22190/FUMB210130007K


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