Hypertension in Cushing’s Syndrome: From Pathogenesis to Treatment

Hypertension is one of the most distinguishing features of endogenous Cushing’s syndrome (CS), as it is present in about 80% of adult patients whereas in children its prevalence is about 47%. Hypertension in CS is significantly correlated with the duration of hypercortisolism and results from the interplay between several pathophysiological mechanisms regulating plasma volume, peripheral vascular resistance and cardiac output, all of which are increased in this state. Glucocorticoids cause hypertension through several mechanisms: their intrinsic mineralocorticoid activity; through activation of the renin-angiotensin system; by enhancement of vasoactive substances, and by causing suppression of the vasodilatory systems. In addition, glucocorticoids may exert some hypertensive effects on cardiovascular regulation through the CNS via both glucocorticoid and mineralocorticoid receptors. Hypertension in CS usually resolves with surgical removal of the tumor, but some patients require pharmacological antihypertensive treatment both preand postoperatively. Thiazides and furosemide should be avoided, while adrenergic blockade and calcium channel antagonists are usually ineffective. Mineralocorticoid receptor antagonists, Ang II blockers and ACE inhibitors are good Published online: September 10, 2010 Franco Mantero Department of Medical and Surgical Sciences Division of Endocrinology, University Clinic Padua Via Ospedale 105, IT–35128 Padua (Italy) Tel. +39 049 821 3000, Fax +39 049 657 391, E-Mail franco.mantero @ unipd.it © 2010 S. Karger AG, Basel 0028–3835/10/0925–0044$26.00/0 Accessible online at: www.karger.com/nen D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /1 9/ 20 17 1 0: 02 :3 6 A M